Association between DXA-derived visceral adiposity and coronary stenosis severity in patients with chronic coronary syndrome: a cross-sectional study

Background. Visceral fat is linked to inflammation, insulin resistance, and atherosclerosis. Dual-energy X-ray absorptiometry (DXA) can estimate visceral adiposity with low radiation exposure, but Vietnamese data remain limited. Objectives. To examine the association of DXA-derived visceral fat with coronary stenosis severity and obstructive coronary artery disease in patients with chronic coronary syndrome. Material and methods. This cross-sectional study included 80 patients undergoing coronary angiography and DXA between June 2025 and April 2026. Obstructive coronary artery disease was defined as ≥50% left main stenosis or ≥70% stenosis in other major coronary segments. Severe stenosis (≥85%) was assessed in an exploratory analysis. Coronary severity was evaluated using maximal stenosis, vessel involvement, Gensini score, and obstructive CAD status. VAT mass was the primary marker. Analyses included group comparisons, Spearman correlation, multivariable regression, and ROC analysis. Results. Mean age was 66.2 ± 12.6 years, 65.0% were women, and 41.3% had obstructive coronary artery disease. Mean VAT mass was 800.7 ± 380.6 g and VAT area was 146.1 ± 51.8 cm2. VAT mass did not differ between groups (p = 0.315). Adjusted regression showed positive associations with Gensini score for VAT mass (B = 2.07 per 100 g, 95% CI 0.40–3.75) and VAT area (B = 1.54 per 10 cm², 95% CI 0.28–2.80). AUCs for conventional obstructive CAD were 0.551 and 0.545, respectively, increasing to 0.648 (95% CI 0.505–0.791) and 0.616 (95% CI 0.470–0.761) for exploratory ≥85% stenosis. Conclusions. DXA-derived visceral adiposity was associated with Gensini score, but its standalone discrimination of obstructive CAD was limited. Exploratory findings warrant caution.