{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T16:56:40Z","timestamp":1778173000312,"version":"3.51.4"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>\n              The relationship between body size and cardiovascular events is complex. This study utilized the ADVANCE (Assessing Diagnostic Value of Noninvasive FFR\n              <jats:sub>CT<\/jats:sub>\n              in Coronary Care) Registry to investigate the association between body mass index (BMI), coronary artery disease (CAD), and clinical outcomes.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>\n              The ADVANCE registry enrolled patients undergoing evaluation for clinically suspected CAD who had &gt;30% stenosis on cardiac computed tomography angiography. Patients were stratified by BMI: normal &lt;25 kg\/m\n              <jats:sup>2<\/jats:sup>\n              , overweight 25\u201329.9 kg\/m\n              <jats:sup>2<\/jats:sup>\n              , and obese \u226530 kg\/m\n              <jats:sup>2<\/jats:sup>\n              . Baseline characteristics, cardiac computed tomography angiography and computed tomography fractional flow reserve (FFR\n              <jats:sub>CT<\/jats:sub>\n              ), were compared across BMI groups. Adjusted Cox proportional hazards models assessed the association between BMI and outcomes.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              Among 5014 patients, 2166 (43.2%) had a normal BMI, 1883 (37.6%) were overweight, and 965 (19.2%) were obese. Patients with obesity were younger and more likely to have comorbidities, including diabetes and hypertension (all\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), but were less likely to have obstructive coronary stenosis (65.2% obese, 72.2% overweight, and 73.2% normal BMI;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). However, the rate of hemodynamic significance, as indicated by a positive FFR\n              <jats:sub>CT<\/jats:sub>\n              , was similar across BMI categories (63.4% obese, 66.1% overweight, and 67.8% normal BMI;\n              <jats:italic>P<\/jats:italic>\n              =0.07). Additionally, patients with obesity had a lower coronary volume-to-myocardial mass ratio compared with patients who were overweight or had normal BMI (obese BMI, 23.7; overweight BMI, 24.8; and normal BMI, 26.3;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). After adjustment, the risk of major adverse cardiovascular events was similar regardless of BMI (all\n              <jats:italic>P<\/jats:italic>\n              &gt;0.05).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>\n              Patients with obesity in the ADVANCE registry were less likely to have anatomically obstructive CAD by cardiac computed tomography angiography but had a similar degree of physiologically significant CAD by FFR\n              <jats:sub>CT<\/jats:sub>\n              and similar rates of adverse events. An exclusively anatomic assessment of CAD in patients with obesity may underestimate the burden of physiologically significant disease that is potentially due to a significantly lower volume-to-myocardial mass ratio.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circimaging.122.014850","type":"journal-article","created":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T18:13:29Z","timestamp":1684260809000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Influence of Obesity on Coronary Artery Disease and Clinical Outcomes in the ADVANCE Registry"],"prefix":"10.1161","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2626-9238","authenticated-orcid":true,"given":"Angela","family":"Lowenstern","sequence":"first","affiliation":[{"name":"Vanderbilt University Medical Center, Nashville, TN (A.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Ng","sequence":"additional","affiliation":[{"name":"HeartFlow, Redwood City, CA (N.N., C.R., S.M., J.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3071-5803","authenticated-orcid":true,"given":"Hidenobu","family":"Takagi","sequence":"additional","affiliation":[{"name":"St. Paul\u2019s Hospital, Radiology, Vancouver, Canada (H.T.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9841-2393","authenticated-orcid":true,"given":"Jennifer A.","family":"Rymer","sequence":"additional","affiliation":[{"name":"Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (J.A.R., L.M.K., P.S.D., J. M. D., M.R.P., M.A.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynne M.","family":"Koweek","sequence":"additional","affiliation":[{"name":"Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (J.A.R., L.M.K., P.S.D., J. M. D., M.R.P., M.A.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9876-4049","authenticated-orcid":true,"given":"Pamela S.","family":"Douglas","sequence":"additional","affiliation":[{"name":"Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (J.A.R., L.M.K., P.S.D., J. M. D., M.R.P., M.A.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica M.","family":"Duran","sequence":"additional","affiliation":[{"name":"Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (J.A.R., L.M.K., P.S.D., J. M. 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