Incremental prognostic value of non-alcoholic fatty liver disease over coronary computed tomography angiography findings in patients with suspected coronary artery disease

Abstract

Aims This study aimed to investigate additional risk stratification benefits of hepatic steatosis (HS) concurrently assessed during coronary computed tomography angiography (CTA) in a large patient cohort with suspected stable coronary artery disease (CAD). Methods and results In this prospective study, 1148 Japanese outpatients without a history of CAD who underwent coronary CTA for suspected stable CAD (mean age 64 ± 14 years) were included. HS, defined on CT as a hepatic-to-spleen attenuation ratio of <1.0, was examined just before the evaluation of adverse CTA findings, defined as obstructive and/or high-risk plaque. The major adverse cardiac events (MACE) were the composite of cardiac death, acute coronary syndrome, and late revascularization. The incremental predictive value of HS was evaluated using the global χ2 test and C-statistic. HS was identified in 247 (22%) patients. During a median follow-up of 3.9 years, MACE was observed in 40 (3.5%) patients. HS was significantly associated with MACE in a model that included adverse CTA findings (hazard ratio 4.01, 95% confidence interval 2.12–7.59, P < 0.001). By adding HS to the Framingham risk score and adverse CTA findings, the global χ2 score and C-statistic significantly increased from 29.0 to 49.5 (P < 0.001) and 0.74 to 0.81 (P = 0.026), respectively. In subgroup analyses in patients with diabetes mellitus and metabolic syndrome, HS had significant additive predictive value for MACE over the Framingham risk score and adverse CTA findings. Conclusion In patients with suspected stable CAD, concurrent evaluation of HS during coronary CTA enables more accurate detection of patients at higher risk of MACE.

High pericoronary adipose tissue attenuation on computed tomography angiography predicts cardiovascular events in patients with type 2 diabetes mellitus: post-hoc analysis from a prospective cohort study

“…The current study population was derived from a prospective, single centre, cohort study comprising Japanese patients who underwent coronary CTA at Okayama University. A study including some patients in this cohort has already been published [ 12 ]. We prospectively gathered data on the clinical features, coronary CTA findings, and patient outcomes.…”

Prognostic Value of Pericoronary Adipose Tissue Attenuation in Patients With Non-alcoholic Fatty Liver Disease With Suspected Coronary Artery Disease

“…Coronary CTA images were obtained using a De nition Flash scanner (Siemens Medical Solutions, Erlangen, Germany) as previously described [4]. On coronary CTA analysis, we evaluated coronary artery segments with a diameter of >2 mm and de ned plaque characteristics in accordance with the Society of Cardiovascular Computed Tomography [14].…”

“…This study was a post-hoc analysis of PCAT attenuation from a prospective cohort study that evaluated the impact of hepatic steatosis on coronary artery disease and its prognosis. The principal study design has been described previously [4]. Brie y, patients who underwent coronary CTA for suspected stable coronary artery disease at Okayama University between August 2011 and December 2016 were enrolled in this cohort study.…”

“…The prevalence of NAFLD in Japan is approximately 30%, and this number is expected to further increase in the future [2,3]. NAFLD is associated with both liver-related and cardiovascular (CV) mortality [4]. Therefore, prevention of CV events in patients with NAFLD is gaining importance as a public health measure.…”

Association of Oxidized Low-Density Lipoprotein in Nonalcoholic Fatty Liver Disease with High-Risk Plaque on Coronary Computed Tomography Angiography: A Matched Case–Control Study

“…While NAFLD primarily affects liver structure and function, leading to morbidity and mortality from liver failure, cardiovascular diseases (CVDs) are the most common cause of death in patients with early NAFLD [ 2 ]. Moreover, emerging evidence has demonstrated that NAFLD is a risk factor for developing atherosclerotic cardiovascular complications, such as stroke and myocardial infarction [ 3 , 4 , 5 ]. We previously reported a significant association between NAFLD and the presence of high-risk plaques (HRP) on coronary computed tomography angiography (CCTA), which increased the likelihood of cardiovascular events [ 6 ].…”