Biswas E, Choudhury A K, Amin M R, Khalequzzaman M, Chowdhury S, Kabir F I, Sakib M M, Mahabub E E, Singha C K
Dr Eshita Biswas, Assistant Professor, Department of Medicine, Dhaka National Medical College and Hospital (DNMC&H), Dhaka, Bangladesh; E-mail:
Mymensingh Med J. 2019 Apr;28(2):382-388.
Acute coronary syndrome (ACS) is one of the leading causes of death throughout the world and obesity especially visceral adiposity is one of the important concerns globally due to its huge impact on coronary artery disease particularly on ACS. There are several traditional methods like BMI, WC, WHR, WHtR etc. but none of these can measure visceral fat accurately. In this regard visceral adiposity index (VAI) is a novel sex specific index which has significant correlation with visceral adiposity and can express the distribution as well as function of visceral fat precisely. This cross sectional study was done in the Cardiology Department of National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from August 2015 to July 2016 to compare the VAI with other adiposity indices for clinical and coronary angiographic severity assessment in patients with acute coronary syndrome. A total of 200 patients (Case 100 patients of ACS and Control 100 patients of non ACS) were included. Afterward clinical, biochemical, echocardiographic and coronary artery angiographic indexes determined by Gensini score were acquired. Adiposity indices like BMI, Waist and Hip circumference, Waist Hip and Waist Height ratio (WHR, WHtR) and finally VAI were calculated using appropriate formula. Patient with ACS had more severe form of clinical features like severe chest pain & shortness of breath (p=0.001), pulse, BP, abnormal precordial findings, BMI, WC, WHR, WHtR, HC, VAI (p=0.001) and angiographic severity (p=0.001) than non ACS group. Multivariate binary logistic regression analysis for clinical and coronary angiographic severity assessment (GS>36) by adiposity indices showed VAI was the better predictor of clinical and coronary angiographic severity assessment with OR's being 5.61 than others. An ROC curve was plotted for each adiposity indices for clinical and coronary angiographic severity assessment showed VAI to have the maximal AUC. A VAI of OR-5.61 was provided as the cutoff value which had a sensitivity of 73.3% and specificity of 76.6% (AUROC=0.839, CI-0.760-0.918, p<0.001) which indicates better than other adiposity indices in patients under study. VAI is an excellent, simple, noninvasive tool to detect the visceral adipose mass & was markedly associated with the clinical and coronary angiographic severity assessment in patients with ACS.
急性冠状动脉综合征（ACS）是全球主要的死亡原因之一，肥胖尤其是内脏脂肪过多是全球重要的关注问题之一，因为它对冠状动脉疾病尤其是对ACS有巨大影响。有几种传统方法，如体重指数（BMI）、腰围（WC）、腰臀比（WHR）、腰高比（WHtR）等，但这些方法都不能准确测量内脏脂肪。在这方面，内脏脂肪指数（VAI）是一种新的性别特异性指数，它与内脏脂肪过多有显著相关性，并且能够精确地表达内脏脂肪的分布和功能。这项横断面研究于2015年8月至2016年7月在孟加拉国达卡国立心血管疾病研究所心脏病科进行，旨在比较VAI与其他肥胖指数，用于急性冠状动脉综合征患者的临床和冠状动脉造影严重程度评估。共纳入200例患者（100例ACS患者为病例组，100例非ACS患者为对照组）。随后获取了临床、生化、超声心动图和通过Gensini评分确定的冠状动脉造影指标。使用适当公式计算肥胖指数，如BMI、腰围和臀围、腰臀比和腰高比（WHR、WHtR），最后计算VAI。与非ACS组相比，ACS患者具有更严重的临床特征，如严重胸痛和呼吸急促（p = 0.001）、脉搏、血压、心前区异常表现、BMI、WC、WHR、WHtR、臀围（HC）、VAI（p = 0.001）以及造影严重程度（p = 0.001）。通过肥胖指数对临床和冠状动脉造影严重程度评估（GS>36）进行多变量二元逻辑回归分析显示，VAI是临床和冠状动脉造影严重程度评估的更好预测指标，其比值比（OR）为5.61，优于其他指标。绘制了每个肥胖指数用于临床和冠状动脉造影严重程度评估的ROC曲线，显示VAI具有最大的曲线下面积（AUC）。提供了OR为5.61的VAI作为临界值，其灵敏度为73.3%，特异性为76.6%（AUROC = 0.839，CI - 0.760 - 0.918，p<0.001），这表明在研究的患者中VAI优于其他肥胖指数。VAI是一种优秀、简单、无创的工具，可用于检测内脏脂肪量，并且与ACS患者的临床和冠状动脉造影严重程度评估显著相关。
