Visceral fat and coronary artery calcification in patients with chronic kidney disease.

BACKGROUND: Abdominal fat is a metabolically active tissue which has been associated with cardiovascular events and death in chronic kidney disease (CKD) patients. We explore here the association between surrogates of abdominal fat and coronary artery calcium score (CACs). METHODS: Cross-sectional analysis of 232 non-dialysis-dependent CKD patients Stages 3-5 (median age 60 [25th-75th percentile 52-67] years; 60% men). Visceral adipose tissue (VAT) and CACs were assessed by computed tomography. Surrogates of abdominal fat included VAT and waist circumference (WC). RESULTS: VAT was positively associated with CACs in univariate analysis (ρ = 0.23). Across increasing VAT quartiles, patients were older, more often men and smokers. Although increasing VAT quartiles associated with higher glomerular filtration rate and leptin, better nutritional status (subjective global assessment) as well as larger muscle stores and strength, they were also more insulin resistant (HOMA-IR), dyslipidemic and inflamed (C-reactive protein and white blood cells). In addition, CACs were incrementally higher. Clinically evident coronary artery calcification (CACs ≥ 10 Agatston) was present in 63% of the patients. Both increased visceral fat (odd ratio 1.60 [95% CI 1.23-2.09] per standard deviation increase) and increased WC (1.05 [1.01-1.12] per cm increase), augmented the odds to present calcification. Such associations remained statistically significant after extensive multivariate adjustment for confounders. CONCLUSIONS: Abdominal fat is associated with coronary artery calcification in non-dialysis dependent CKD patients, supporting its potential role as a cardiovascular risk factor in uremia.

Visceral fat and coronary artery calcification in patientswith chronic kidney disease

Background. Abdominal fat is a metabolically active tissuewhich has been associated with cardiovascular events anddeath in chronic kidney disease (CKD) patients. We explorehere the association between surrogates of abdominal fat andcoronary artery calcium score (CACs).Methods. Cross-sectional analysis of 232 non-dialysisdependentCKD patients Stages 3–5 (median age 60 [25th–75thpercentile 52–67] years; 60% men). Visceral adipose tissue(VAT) and CACs were assessed by computed tomography. Surrogatesof abdominal fat included VAT and waist circumference(WC).Results. VAT was positively associated with CACs in univariateanalysis (ρ = 0.23). Across increasing VAT quartiles,patients were older, more often men and smokers. Althoughincreasing VAT quartiles associated with higher glomerular filtrationrate and leptin, better nutritional status (subjectiveglobal assessment) as well as larger muscle stores and strength,they were also more insulin resistant (HOMA-IR), dyslipidemicand inflamed (C-reactive protein and white blood cells).In addition, CACs were incrementally higher. Clinicallyevident coronary artery calcification (CACs ≥ 10 Agatston) was present in 63% of the patients. Both increased visceral fat(odd ratio 1.60 [95% CI 1.23–2.09] per standard deviation increase)and increased WC (1.05 [1.01–1.12] per cm increase),augmented the odds to present calcification. Such associationsremained statistically significant after extensive multivariateadjustment for confounders.Conclusions. Abdominal fat is associated with coronary arterycalcification in non-dialysis dependent CKD patients, supportingits potential role as a cardiovascular risk factor in uremia.

Dipyridamole stress and rest transmural myocardial perfusion ratio evaluation by 64 detector-row computed tomography.

BACKGROUND: Myocardial stress CT perfusion (CTP) can detect myocardial ischemia. OBJECTIVE: We evaluated the transmural perfusion ratio (TPR) of dipyridamole stress CTP to detect significant coronary stenosis (>70%) defined by quantitative invasive coronary angiography (ICA). METHODS: Twenty-six patients (61.6 ± 8.0 years old; 14 males), without prior myocardial infarction, with positive single-photon emission computed tomography (SPECT; <2 months) and clinical indication for ICA, underwent a customized multidetector-row CT (MDCT) protocol with rest/stress myocardial perfusion evaluation and coronary CT angiography. TPR was defined as mean subendocardial divided by mean subepicardial attenuation and quantified on rest and stress MDCT images. Abnormal TPR was defined as 2 SDs below the mean rest TPR. RESULTS: All 26 patients completed the CT protocol with no adverse events. Rest TPR was measured in all patients with a mean of 1.06 ± 0.11, and abnormal TPR was considered <0.85. For 6 patients with normal coronary arteries by ICA, the mean TPR of territories with a previous positive perfusion defect in SPECT was 1.02 ± 0.18 (95% CI, 0.86-1.18; n = 6), and mean TPR of territories without perfusion defect in SPECT was 1.03 ± 0.09 (95% CI, -0.95 to 1.11; n = 12; P = 0.83). Mean stress TPR in territories with positive SPECT and significant coronary artery disease by quantitative ICA was 0.71 ± 0.13 (95% CI, -0.64 to 0.77) and in the remote myocardial was 1.01 ± 0.09 (95% CI, -0.96 to 1.06; P < 0001). In these territories, a significant Pearson's correlation was observed (r = -0.74, P < 0.001). CONCLUSION: TPR has a good correlation with SPECT and ICA to detect significant coronary stenosis.