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Association between Abdominal Fat Distribution and severity of Coronary Artery Disease: data from a large cohort of patients submitted to cardiac CT scan
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 13 - FRONTEIRAS INOVADORAS NO DIAGNÓSTICO DA DOENÇA ARTERIAL CORONÁRIA E AVALIAÇÃO DE RISCO: DA IMAGEM AVANÇADA AOS RESULTADOS CLÍNICOS
Speaker:
Cátia Isabel Fernandes Da Costa
Congress:
CPC 2025
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.3 Coronary Artery Disease – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Cátia Costa; Fábio Sousa Nunes; António S. Barros; João Manuel Pedrosa; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Background: </strong>Obesity is known as an important risk factor for the development of coronary artery disease (CAD). However, recent studies have suggested that abdominal fat distribution (AFD), such as the ratio between visceral and subcutaneous adipose tissue area, can be a stronger predictor of the presence and severity of CAD. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Aim: </strong>We aimed to evaluate the association between different ratios of AFD, such as subcutaneous adipose tissue volume (SATVol) and visceral adipose tissue volume (VATVol) to Body Mass Index (BMI), SATVol and VATVol to total abdominal volume (AbdVol), and VATVol to SATVol, with CAD severity, assessed by coronary computed tomography angiography (CCTA) and the CAD-RADS classification system.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Methods: </strong>Retrospective analysis including 1641 patients who underwent CCTA for CAD assessment (2006–2023). Beyond cardiac CT, all patients acquired a single slice CT scan at abdominal level (L4/L5-S1 level). CAD-RADS data were extracted, and abdominal fat volumes (visceral and subcutaneous) were measured by filtering voxels with attenuation values between -150 and -50 HU. The association between AFD and the CAD-RADS was assessed using Welch's test and pairwise Games-Howell test.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Results: </strong>From the 1641 patients (mean age 57±10 years; 57% male),<strong> </strong>62% were classified as CAD-RADS 0, 14% as CAD-RADS 1, 4% as CAD-RADS 2, 13% as CAD-RADS 3, 4% CAD-RADS 4, and 3% as CAD-RADS 5.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Overall, an increase in all VATVol ratios was associated with greater CAD severity. </span></span><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">The strongest association was observed with VATVol/BMI ratio (p<0.0001; log<sub>e</sub>(BF<sub>01</sub>)=-59.17), with the mean VATVol/BMI ratio increasing as CAD severity worsened. The second-strongest association with CAD severity was observed with VATVol/AbdVol ratio (p<0.0001; log<sub>e</sub>(BF<sub>01</sub>)=-47.91), followed by the VATVol/SATVol ratio (p<0.0001; log<sub>e</sub>(BF<sub>01</sub>)=-43.61).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">The SATVol/AbdVol ratio inversely correlated with CAD severity (p<0.0001; log<sub>e</sub>(BF<sub>01</sub>)=-39.96), with its mean decreasing as CAD severity worsened. A similar pattern was observed for the SATVol/BMI ratio, although with a weaker magnitude of evidence (p<0.0001; log<sub>e</sub>(BF<sub>01</sub>)=-8.31).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion:</strong> This study showed that the pattern of AFD is associated with CAD severity, particularly the ratios of VATVol/BMI and SATVol/AbdVol. These findings highlight the distinct roles of VAT and SAT in cardiovascular risk, with VAT linked to worsening CAD and SAT having a more beneficial metabolic effect. These data can be useful for individualized CAD risk stratification.</span></span></p>
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