{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T05:38:56Z","timestamp":1792647536281,"version":"4.5.0"},"reference-count":46,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,10,20]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Body mass index is a widely\u2010used yet imprecise measure of adiposity. Thoracic intermuscular adiposity is reported to be related with coronary microvascular dysfunction (CMD), but their prognostic implications after cardiac surgery are not clear. This study aimed to investigate whether computed tomography\u2013derived thoracic intermuscular adiposity and CMD provide better prognostic information than body mass index in patients undergoing cardiac surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      This study consecutively enrolled 666 patients undergoing elective surgery from 3 centers. Using computed tomography at the T12 vertebral level, we quantified the cross\u2010sectional areas (cm\n                      <jats:sup>2<\/jats:sup>\n                      ) of skeletal muscle, subcutaneous adipose tissue, and intermuscular adipose tissue. Intermuscular fat fraction was calculated as intermuscular adipose tissue\/(intermuscular adipose tissue+skeletal muscle)\u00d7100%. CMD was defined by a coronary angiography\u2010derived index of microcirculatory resistance &gt;25. The primary end point was major adverse cardiovascular events (MACE), a composite of all\u2010cause mortality, myocardial infarction, and rehospitalization for heart failure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      A total of 63 MACEs (9.5%) occurred during a median 17\u2010month follow\u2010up. Obesity defined by body mass index (10.7% of patients) was not associated with MACE (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.187). Each 1% increase in intermuscular fat fraction was significantly associated with CMD (adjusted odds ratio, 1.22 [95% CI, 1.14\u20131.31];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001), whereas body mass index showed no such correlation (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.964). CMD independently predicted MACE (adjusted hazard ratio, 2.03; [95% CI: 1.15\u20133.61];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      \u2009=\u20090.015), whereas intermuscular fat fraction did not (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.516). The annualized MACE rate was significantly higher in patients with CMD (11.0% versus 5.2%,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.004).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Computed tomography\u2010derived intermuscular adiposity correlated strongly with CMD, and preprocedural CMD was associated with a higher risk of MACE after cardiac surgery. External validation and prospective studies are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.126.053125","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T12:01:00Z","timestamp":1791633660000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Thoracic Intermuscular Adiposity, Coronary Microvascular Dysfunction, and Prognosis After Cardiac Surgery"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9250-0982","authenticated-orcid":false,"given":"You","family":"Zhou","sequence":"first","affiliation":[{"name":"Shanghai Geriatric Medical Center","place":["Shanghai, China"]},{"name":"Zhongshan Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9800-5369","authenticated-orcid":false,"given":"Jie","family":"Cui","sequence":"additional","affiliation":[{"name":"Shanghai Geriatric Medical Center","place":["Shanghai, China"]},{"name":"Zhongshan Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6641-6162","authenticated-orcid":false,"given":"Jinjuan","family":"Lu","sequence":"additional","affiliation":[{"name":"Shanghai Geriatric Medical Center","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zilong","family":"Wang","sequence":"additional","affiliation":[{"name":"Microsoft Research Asia","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1388-2094","authenticated-orcid":false,"given":"Jinqiang","family":"Shen","sequence":"additional","affiliation":[{"name":"Shanghai Geriatric Medical Center","place":["Shanghai, China"]},{"name":"Zhongshan Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0701-1194","authenticated-orcid":false,"given":"Xiaonan","family":"Zhou","sequence":"additional","affiliation":[{"name":"Shanghai Geriatric Medical Center","place":["Shanghai, China"]},{"name":"Zhongshan Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4753-335X","authenticated-orcid":false,"given":"Danbo","family":"Lu","sequence":"additional","affiliation":[{"name":"Shanghai Geriatric Medical Center","place":["Shanghai, China"]},{"name":"Zhongshan Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lixiang","family":"Deng","sequence":"additional","affiliation":[{"name":"Shanghai Geriatric Medical Center","place":["Shanghai, China"]},{"name":"Zhongshan Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhe","family":"Wang","sequence":"additional","affiliation":[{"name":"Shanghai Geriatric Medical Center","place":["Shanghai, China"]},{"name":"Zhongshan Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Liu","sequence":"additional","affiliation":[{"name":"Shanghai Geriatric Medical Center","place":["Shanghai, China"]},{"name":"Zhongshan Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7375-1299","authenticated-orcid":false,"given":"Peipei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Shanghai Geriatric Medical Center","place":["Shanghai, China"]},{"name":"Zhongshan Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1813-9778","authenticated-orcid":false,"given":"Yiqing","family":"Hu","sequence":"additional","affiliation":[{"name":"Zhongshan Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5856-1287","authenticated-orcid":false,"given":"Chunsheng","family":"Wang","sequence":"additional","affiliation":[{"name":"Shanghai Geriatric Medical Center","place":["Shanghai, China"]},{"name":"Zhongshan Hospital, Fudan University","place":["Shanghai, China"]},{"name":"Zhongshan Hospital, Fudan University (Xiamen Branch)","place":["Xiamen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6908-3674","authenticated-orcid":false,"given":"Mingliang","family":"Wang","sequence":"additional","affiliation":[{"name":"Shanghai Geriatric Medical Center","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0322-4400","authenticated-orcid":false,"given":"Hao","family":"Lu","sequence":"additional","affiliation":[{"name":"Zhongshan Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7512-3692","authenticated-orcid":false,"given":"Juying","family":"Qian","sequence":"additional","affiliation":[{"name":"Zhongshan Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2022.155217"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-023-00847-5"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.12.068"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1614362"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.120.316101"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2013.05.028"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2023-322459"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.022840"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1160\/TH13-04-0285"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.11.058"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(19)30084-1"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad083"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-018-0754-z"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaf131"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003223"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-024-10953-8"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2023.07.014"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae827"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000080700.98607.D1"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa503"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2020.605356"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/s1010-7940(99)00134-7"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.12290\/xhyxzz.2024-0918"},{"key":"e_1_3_1_25_2","unstructured":"Blankemeier L Desai AD Chaves JMZ Wentland AL Yao S Reis E Jensen MEK Bahl B Arora K Patel BN et\u00a0al. Comp2Comp: open\u2010source body composition assessment on computed tomography. ArXiv2023:abs\/2302.06568."},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41592-020-01008-z"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1148\/ryai.230024"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvz289"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(24)00316-4"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.02.055"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2020.12.016"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000000602"},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0029665115000129"},{"key":"e_1_3_1_34_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41574-022-00784-2"},{"key":"e_1_3_1_35_2","doi-asserted-by":"publisher","DOI":"10.3390\/biom10020291"},{"key":"e_1_3_1_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2013.06.004"},{"key":"e_1_3_1_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2020.02.031"},{"key":"e_1_3_1_38_2","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvaa009"},{"key":"e_1_3_1_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.07.042"},{"key":"e_1_3_1_40_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-020-00789-y"},{"key":"e_1_3_1_41_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.025268"},{"key":"e_1_3_1_42_2","doi-asserted-by":"publisher","DOI":"10.1097\/SHK.0000000000001713"},{"key":"e_1_3_1_43_2","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.13108"},{"key":"e_1_3_1_44_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(18)30288-2"},{"key":"e_1_3_1_45_2","doi-asserted-by":"publisher","DOI":"10.1111\/obr.13520"},{"key":"e_1_3_1_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.xcrm.2025.102309"},{"key":"e_1_3_1_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)15268-3"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.126.053125","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T04:54:52Z","timestamp":1792644892000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.126.053125"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,20]]},"references-count":46,"journal-issue":{"issue":"20","published-print":{"date-parts":[[2026,10,20]]}},"alternative-id":["10.1161\/JAHA.126.053125"],"URL":"https:\/\/doi.org\/10.1161\/jaha.126.053125","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,20]]},"assertion":[{"value":"2026-06-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e053125"}}