基于CT的内脏脂肪组织指数和甘油三酯-葡萄糖指数对非体外循环冠状动脉旁路移植术后新发心房颤动的预测价值：一项纵向研究分析
Predictive Value of the CT-Based Visceral Adiposity Tissue Index and Triglyceride-Glucose Index on New-Onset Atrial Fibrillation after Off-Pump Coronary Artery Bypass Graft: Analyses from a Longitudinal Study.
作者信息
Peng Zhan, Zhao Rui, Yang Yunxiao, Hua Kun, Yang Xiubin
机构信息
Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Vessel Disease, 100029 Beijing, China.
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China.
出版信息
Rev Cardiovasc Med. 2023 Nov 30;24(11):338. doi: 10.31083/j.rcm2411338. eCollection 2023 Nov.
BACKGROUND
The visceral-adiposity-tissue index (VATI) and the triglyceride-glucose (TyG) index were found to be correlated with an increased risk of cardiovascular events. However, data concerning the association between the visceral adiposity/TyG indexes and the complication of new-onset postoperative atrial fibrillation (POAF), especially in patients who had just undergone off-pump coronary artery bypass grafting (OPCABG), are rare. We explored the predictive value of the computed-tomography-based VATI and the TyG index on new-onset POAF after OPCABG.
METHODS
This study used longitudinal data from the cohort of 542 participants who underwent OPCABG in Beijing Anzhen Hospital since June 2017. The predictive relevance of the VATI and TyG index were evaluated through Cox proportional hazards models and receiver operating characteristic (ROC) curves. The dose‒response relationship of the VATI and TyG index with new-onset POAF was analyzed by multiple-adjusted spline regression models, and sensitivity analysis was used to explore the stability of our findings.
RESULTS
The analysis found that the highest tertile of VATI [hazard ratio (HR) 2.58, 95% confidence interval (CI) 1.12-3.45; = 0.01] and TyG index (HR 2.88, 95% CI 1.76-4.71; = 0.01) were significantly associated with new-onset POAF compared to the lowest tertile after full adjustment for age, sex, body mass index, c-reactive protein levels, diabetes, emergency operation, New York Heart Association (NYHA) III-IV, and left atrial diameter. The area under the ROC curve (AUC) was 0.897 ( 0.001) and 0.878 ( 0.001) for the VATI and TyG index, respectively. In addition, the multiple-adjusted spline regression models showed a nonlinear relationship between new-onset POAF and VATI and TyG index ( for nonlinearity 0.001). Sensitivity analyses confirmed that the results were similar for most tertiles.
CONCLUSIONS
The VATI and TyG index were significantly associated with an increased risk for the development of new-onset POAF after OPCABG.
CLINICAL TRIAL REGISTRATION
NCT03729531, https://beta.clinicaltrials.gov/study/NCT03729531.
背景
内脏脂肪组织指数（VATI）和甘油三酯-葡萄糖（TyG）指数与心血管事件风险增加相关。然而，关于内脏脂肪/TyG指数与新发术后心房颤动（POAF）并发症之间关联的数据，尤其是在刚接受非体外循环冠状动脉旁路移植术（OPCABG）的患者中，却很罕见。我们探讨了基于计算机断层扫描的VATI和TyG指数对OPCABG术后新发POAF的预测价值。
方法
本研究使用了自2017年6月以来在北京安贞医院接受OPCABG的542名参与者队列的纵向数据。通过Cox比例风险模型和受试者工作特征（ROC）曲线评估VATI和TyG指数的预测相关性。采用多因素调整样条回归模型分析VATI和TyG指数与新发POAF的剂量-反应关系，并进行敏感性分析以探讨研究结果的稳定性。
结果
分析发现，在对年龄、性别、体重指数、C反应蛋白水平、糖尿病、急诊手术、纽约心脏协会（NYHA）III-IV级和左心房直径进行全面调整后，与最低三分位数相比，VATI的最高三分位数[风险比（HR）2.58，95%置信区间（CI）1.12-3.45；P = 0.01]和TyG指数（HR 2.88，95% CI 1.76-4.71；P = 0.01）与新发POAF显著相关。VATI和TyG指数的ROC曲线下面积（AUC）分别为0.897（P < 0.001）和0.878（P < 0.001）。此外，多因素调整样条回归模型显示新发POAF与VATI和TyG指数之间存在非线性关系（非线性P < 0.001）。敏感性分析证实，大多数三分位数的结果相似。
结论
VATI和TyG指数与OPCABG术后新发POAF的发生风险增加显著相关。
临床试验注册
NCT03729531，https://beta.clinicaltrials.gov/study/NCT03729531。
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