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Visceral Fat Area Is a Better Predictor Than Coronary Artery Calcification Score for Cardiovascular Outcomes and
Yuqin Xiong1, Yang Yu1, Heng Jiang2
1Department of Nephrology, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Disaster Medicine Center, Sichuan University, Chengdu, People's Republic of China; Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, People's Republic of China.
Insights
Visceral fat area (VFA) predicts cardiovascular events and mortality in hemodialysis patients, unlike coronary artery calcification score (CACs). Increased VFA is a key prognostic indicator for this population.
Area of Science:
- Nephrology
- Cardiology
- Medical Imaging
Background:
- Patients on maintenance hemodialysis face high risks of cardiovascular events and mortality.
- Visceral fat area (VFA) and coronary artery calcification score (CACs) are potential prognostic markers.
- The comparative prognostic value of VFA versus CACs in this population requires clarification.
Purpose of the Study:
- To compare the prognostic effects of visceral fat area (VFA) and coronary artery calcification score (CACs) in patients undergoing maintenance hemodialysis.
- To determine if VFA is an independent predictor of cardiovascular events, cardiovascular death, and all-cause mortality.
Main Methods:
- Prospective study involving 97 Chinese hemodialysis patients.
- Baseline data included clinical characteristics, biochemical indexes, body composition (bioelectrical impedance analysis), VFA and CACs (CT scan), and echocardiography.
- Primary endpoints were cardiovascular events (CVEs), cardiovascular death (CVD), and all-cause mortality.
Main Results:
- Visceral fat area (VFA) was significantly associated with CVEs (HR=9.21), CVD (HR=1.11 per cm²), and all-cause mortality (HR=1.08 per cm²).
- VFA also correlated with cardiac structure changes and left ventricular hypertrophy (OR=1.02 per cm²).
- Coronary artery calcification score (CACs) did not show a significant correlation with CVEs, CVD, or all-cause mortality.
Conclusions:
- Elevated visceral fat area (VFA) serves as an independent predictor for cardiovascular events and mortality in hemodialysis patients.
- VFA's impact on cardiac remodeling may explain its prognostic significance.
- Further research is needed to guide VFA management strategies in hemodialysis populations.
Objectives:
The aim of this study is to compare the prognostic effects of visceral fat area (VFA) with coronary artery calcification score (CACs) in patients on maintenance hemodialysis.
Design And Methods:
In the prospective study with no intervention, clinical characteristics and serum biochemical indexes at baseline for each patient were collected through the electronic medical records. Body composition assessment using bioelectrical impedance analysis, computed tomography examination with the Agatston scoring method, and echocardiographic measurements were performed at enrollment. Primary endpoints included cardiovascular events (CVEs), cardiovascular death (CVD), and all-cause death.
Results:
A total of 97 Chinese patients aged 48 (35-62) years were enrolled from our Hemodialysis Center, of which 61.9% were male and 20.6% had diabetes. The median of VFA and CACs at baseline was 64.5 (43.5-88.7) cm2 and 0.9 (0-467.6), respectively. CVEs occurred in 20 (20.6%) patients during a median follow-up of 26.4 (13-27.7) months. The cardiovascular and all-cause mortality was 8.2% (8 patients) and 11.3% (11 patients), respectively. VFA was associated with CVEs (hazard ratio [HR] = 9.21 for VFA ≥71.3 cm2 vs. VFA <71.3 cm2, P = .017), CVD (HR = 1.11 for 1 cm2 increase, P = .035), and all-cause mortality (HR = 1.08 for 1 cm2 increase, P = .011). Also, VFA was significantly correlated with cardiac structure parameters and the development of left ventricular hypertrophy (odds ratio = 1.02 for 1 cm2 increase, P = .03). Yet, CACs were not correlated with CVEs, CVD, or all-cause mortality.
Conclusions:
Increased VFA can be used as an independent predictor for CVEs, CVD, and all-cause mortality. The effect VFA exerts on cardiac reconstruction might be the underlying mechanism. Further studies are warranted for the management of VFA in the hemodialysis population.
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