Navkaranbir S Bajaj1, Michael T Osborne2, Ankur Gupta1, Ali Tavakkoli3, Paco E Bravo1, Tomas Vita1, Courtney F Bibbo1, Jon Hainer1, Sharmila Dorbala4, Ron Blankstein4, Deepak L Bhatt5, Marcelo F Di Carli4, Viviany R Taqueti6. 1. Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 2. Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Cardiac MR/PET/CT Program, Departments of Medicine and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 3. Center for Weight Management and Metabolic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 4. Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts. 5. Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts. Electronic address: https://twitter.com/DLBHATTMD. 6. Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts. Electronic address: vtaqueti@bwh.harvard.edu.
Abstract
BACKGROUND: Besides body mass index (BMI), other discriminators of cardiovascular risk are needed in obese patients, who may or may not undergo consideration for bariatric surgery. Coronary microvascular dysfunction (CMD), defined as impaired coronary flow reserve (CFR) in the absence of flow-limiting coronary artery disease, identifies patients at risk for adverse events independently of traditional risk factors. OBJECTIVES: The study sought to investigate the relationship among obesity, CMD, and adverse outcomes. METHODS: Consecutive patients undergoing evaluation for coronary artery disease with cardiac stress positron emission tomography demonstrating normal perfusion (N = 827) were followed for median 5.6 years for events, including death and hospitalization for myocardial infarction or heart failure. RESULTS: An inverted independent J-shaped relationship was observed between BMI and CFR, such that in obese patients CFR decreased linearly with increasing BMI (adjusted p < 0.0001). In adjusted analyses, CFR but not BMI remained independently associated with events (for a 1-U decrease in CFR, adjusted hazard ratio: 1.95; 95% confidence interval: 1.41 to 2.69; p < 0.001; for a 10-U increase in BMI, adjusted hazard ratio: 1.20; 95% confidence interval: 0.95 to 1.50; p = 0.125) and improved model discrimination (C-index 0.71 to 0.74). In obese patients, individuals with impaired CFR demonstrated a higher adjusted rate of events (5.7% vs. 2.6%; p = 0.002), even in those not currently meeting indications for bariatric surgery (6.4% vs. 2.6%; p = 0.04). CONCLUSIONS: In patients referred for testing, CMD was independently associated with elevated BMI and adverse outcomes, and was a better discriminator of risk than BMI and traditional risk factors. CFR may facilitate management of obese patients beyond currently used markers of risk.
BACKGROUND: Besides body mass index (BMI), other discriminators of cardiovascular risk are needed in obesepatients, who may or may not undergo consideration for bariatric surgery. Coronary microvascular dysfunction (CMD), defined as impaired coronary flow reserve (CFR) in the absence of flow-limiting coronary artery disease, identifies patients at risk for adverse events independently of traditional risk factors. OBJECTIVES: The study sought to investigate the relationship among obesity, CMD, and adverse outcomes. METHODS: Consecutive patients undergoing evaluation for coronary artery disease with cardiac stress positron emission tomography demonstrating normal perfusion (N = 827) were followed for median 5.6 years for events, including death and hospitalization for myocardial infarction or heart failure. RESULTS: An inverted independent J-shaped relationship was observed between BMI and CFR, such that in obesepatients CFR decreased linearly with increasing BMI (adjusted p < 0.0001). In adjusted analyses, CFR but not BMI remained independently associated with events (for a 1-U decrease in CFR, adjusted hazard ratio: 1.95; 95% confidence interval: 1.41 to 2.69; p < 0.001; for a 10-U increase in BMI, adjusted hazard ratio: 1.20; 95% confidence interval: 0.95 to 1.50; p = 0.125) and improved model discrimination (C-index 0.71 to 0.74). In obesepatients, individuals with impaired CFR demonstrated a higher adjusted rate of events (5.7% vs. 2.6%; p = 0.002), even in those not currently meeting indications for bariatric surgery (6.4% vs. 2.6%; p = 0.04). CONCLUSIONS: In patients referred for testing, CMD was independently associated with elevated BMI and adverse outcomes, and was a better discriminator of risk than BMI and traditional risk factors. CFR may facilitate management of obesepatients beyond currently used markers of risk.
Authors: Manuel D Cerqueira; Neil J Weissman; Vasken Dilsizian; Alice K Jacobs; Sanjiv Kaul; Waren K Laskey; Dudley J Pennell; John A Rumberger; Thomas Ryan; Mario S Verani Journal: Int J Cardiovasc Imaging Date: 2002-02 Impact factor: 2.357
Authors: Benjamin J W Chow; Sharmila Dorbala; Marcelo F Di Carli; Michael E Merhige; Brent A Williams; Emir Veledar; James K Min; Michael J Pencina; Yeung Yam; Li Chen; Sai Priya Anand; Terrence D Ruddy; Daniel S Berman; Leslee J Shaw; Rob S Beanlands Journal: JACC Cardiovasc Imaging Date: 2014-02-19
Authors: Manan Pareek; Philip R Schauer; Lee M Kaplan; Lawrence A Leiter; Francesco Rubino; Deepak L Bhatt Journal: J Am Coll Cardiol Date: 2018-02-13 Impact factor: 24.094
Authors: Viviany R Taqueti; Scott D Solomon; Amil M Shah; Akshay S Desai; John D Groarke; Michael T Osborne; Jon Hainer; Courtney F Bibbo; Sharmila Dorbala; Ron Blankstein; Marcelo F Di Carli Journal: Eur Heart J Date: 2018-03-07 Impact factor: 29.983
Authors: Viviany R Taqueti; Leslee J Shaw; Nancy R Cook; Venkatesh L Murthy; Nishant R Shah; Courtney R Foster; Jon Hainer; Ron Blankstein; Sharmila Dorbala; Marcelo F Di Carli Journal: Circulation Date: 2016-11-14 Impact factor: 29.690
Authors: R J Gibbons; K Chatterjee; J Daley; J S Douglas; S D Fihn; J M Gardin; M A Grunwald; D Levy; B W Lytle; R A O'Rourke; W P Schafer; S V Williams; J L Ritchie; M D Cheitlin; K A Eagle; T J Gardner; A Garson; R O Russell; T J Ryan; S C Smith Journal: J Am Coll Cardiol Date: 1999-06 Impact factor: 24.094
Authors: Viviany R Taqueti; Sharmila Dorbala; David Wolinsky; Brian Abbott; Gary V Heller; Timothy M Bateman; Jennifer H Mieres; Lawrence M Phillips; Nanette K Wenger; Leslee J Shaw Journal: J Nucl Cardiol Date: 2017-06-05 Impact factor: 5.952
Authors: David T Harnett; Samir Hazra; Ronnen Maze; Brian A Mc Ardle; Ali Alenazy; Trevor Simard; Ellen Henry; Girish Dwivedi; Christopher Glover; Robert A deKemp; Ross A Davies; Terrence D Ruddy; Benjamin J W Chow; Rob S Beanlands; Benjamin Hibbert Journal: J Nucl Cardiol Date: 2017-03-29 Impact factor: 5.952
Authors: Apurva A Motivala; Patricia A Rose; H Myra Kim; Yolanda R Smith; Catherine Bartnik; Robert D Brook; Otto Muzik; Claire S Duvernoy Journal: J Nucl Cardiol Date: 2008-04-08 Impact factor: 5.952
Authors: Navkaranbir S Bajaj; Amitoj Singh; Wunan Zhou; Ankur Gupta; Kana Fujikura; Christina Byrne; Hendrik J Harms; Michael T Osborne; Paco Bravo; Efstathia Andrikopolou; Sanjay Divakaran; Courtney F Bibbo; Jon Hainer; Hicham Skali; Viviany Taqueti; Michael Steigner; Sharmila Dorbala; David M Charytan; Sumanth D Prabhu; Ron Blankstein; Rahul C Deo; Scott D Solomon; Marcelo F Di Carli Journal: Circulation Date: 2019-11-29 Impact factor: 29.690
Authors: Maloree Khan; Alex I Meuth; Scott M Brown; Bysani Chandrasekar; Douglas K Bowles; Shawn B Bender Journal: Am J Physiol Heart Circ Physiol Date: 2019-06-14 Impact factor: 4.733
Authors: Harmony R Reynolds; C Noel Bairey Merz; Colin Berry; Rohit Samuel; Jacqueline Saw; Nathaniel R Smilowitz; Ana Carolina do A H de Souza; Robert Sykes; Viviany R Taqueti; Janet Wei Journal: Circ Res Date: 2022-02-17 Impact factor: 17.367
Authors: Ana Carolina do A H de Souza; Hendrik J Harms; Laurel Martell; Courtney Bibbo; Meagan Harrington; Kyle Sullivan; Jon Hainer; Sharmila Dorbala; Ron Blankstein; Viviany R Taqueti; Marie Foley Kijewski; Mi-Ae Park; Alejandro Meretta; Christopher Breault; Nathaniel Roth; Alexis Poitrasson-Rivière; Prem Soman; Grant T Gullberg; Marcelo F Di Carli Journal: Circ Cardiovasc Imaging Date: 2022-06-08 Impact factor: 8.589
Authors: Tiffany M Powell-Wiley; Paul Poirier; Lora E Burke; Jean-Pierre Després; Penny Gordon-Larsen; Carl J Lavie; Scott A Lear; Chiadi E Ndumele; Ian J Neeland; Prashanthan Sanders; Marie-Pierre St-Onge Journal: Circulation Date: 2021-04-22 Impact factor: 29.690
Authors: Christopher L Schumann; Roshin C Mathew; John-Henry L Dean; Yang Yang; Pelbreton C Balfour; Peter W Shaw; Austin A Robinson; Michael Salerno; Christopher M Kramer; Jamieson M Bourque Journal: JACC Cardiovasc Imaging Date: 2021-04-14
Authors: John D Groarke; Sanjay Divakaran; Anju Nohria; Joseph H Killoran; Sharmila Dorbala; Ruth M Dunne; Jon Hainer; Viviany R Taqueti; Ron Blankstein; Harvey J Mamon; Marcelo F Di Carli Journal: J Nucl Cardiol Date: 2020-07-20 Impact factor: 5.952