Association of visceral adiposity index (VAI) with prognosis in patients with metabolic syndrome and heart failure with reduced ejection fraction

Background Visceral Adiposity Index (VAI) is an effective predictor of metabolic syndrome (MetS) and serves as a marker of visceral adiposity. The association between the VAI index and poor prognosis in patients with MetS and Heart failure with reduced ejection fraction (HFrEF) remains unclear. The aim of this study is to evaluate the relationship between VAI and endpoint events in patients with metabolic syndrome and HFrEF. Methods This study was a single-center retrospective cohort study. A total of 809 patients with MetS and HFrEF admitted to Hangzhou Hospital of Zhejiang Medical Group from January 2014 to September 2021 were consecutively included. The VAI index was calculated based on anthropometric measurements and laboratory examination results at admission, and patients were grouped according to tertiles of VAI index. All patients were followed for 24 months, and the incidence of cardiac death and readmission for heart failure was recorded. Results For different clinical endpoint events, there were significant differences in event-free survival between tertiles of VAI index. The risk of cardiac death [hazard ratio (HR):3.402, 95%CI:2.123-5.449, P < 0.001] and heart failure readmission (HR:4.862, 95%CI:3.605-6.557, P < 0.001) increased with the increase of tertile of VAI index. Multivariate COX regression analysis adjusted for other confounding factors showed that VAI was an independent predictor of clinical adverse endpoint events. The predictive value of VAI for cardiac death [Area under curve (AUC):0.649, 95%CI:0.602-0.697, P < 0.001] and heart failure readmission (AUC:0.693, 95%CI:0.656-0.729, P < 0.001) was higher than that of other variables. Conclusions In patients with HFrEF at risk for comorbid metabolic diseases, baseline VAI levels on admission were associated with the occurrence of adverse outcomes during follow-up.