What is the clinical evidence from this study?

Study design: Observational. Population: Suspected angina due to coronary heart disease (n=1726). Intervention: Hepatosteatosis at CT vs. No hepatosteatosis at CT. Primary outcome: Low-attenuation plaque burden (p=0.04).

April 1, 2022Open Access

Hepatosteatosis and Atherosclerotic Plaque at Coronary CT Angiography

JCJessica CarterUniversity of Edinburgh THThomas HeseltineUniversity of Liverpool MMMohammed N. MeahUniversity of Liverpool

Resultado clave

Hepatosteatosis at CT was associated with a higher low-attenuation plaque burden compared to those without hepatosteatosis, but this was not independent of cardiovascular risk factors.

Diseño del estudio

Tipo

Observational (n=1,726)

Enmascaramiento

Blinded to clinical information and outcomes

Multicéntrico

Sí

PICO estructurado

Does hepatosteatosis at CT predict increased quantitative atherosclerotic plaque burden and cardiovascular events in patients with suspected angina?

Población

1,726 participants (mean age 58 ± 9 years, 56% male) referred to outpatient cardiology chest pain clinics with suspected angina due to coronary heart disease. Exclusions included inability to undergo CT, renal failure (eGFR < 30 mL/min/1.73 m2), allergy to iodine-based contrast, pregnancy, and acute coronary syndrome within the previous 3 months.

Intervención

Presence of hepatosteatosis (nonalcoholic fatty liver disease) identified at noncontrast CT (defined as liver attenuation < 40 HU)

Comparador

Absence of hepatosteatosis at noncontrast CT (liver attenuation ≥ 40 HU)

Resultado

Quantitative atherosclerotic plaque burden (including total, calcified, noncalcified, and low-attenuation plaque), coronary artery calcium score, and presence of stenoses at coronary CT angiographysurrogate

Hepatosteatosis identified on cardiac CT is associated with increased high-risk coronary plaque burden, but this relationship is driven by coexisting traditional cardiovascular risk factors rather than being an independent risk marker.

Resultado numérico

Tasa de eventos absoluta: 5.11% vs 4.07%

valor p: p=0.04

Limitaciones

Post hoc analysis of previously collected data with no formal power calculation
Small number of subsequent cardiovascular events
Participants represented those undergoing assessment of suspected coronary artery disease, limiting generalizability
Lack of information on alcohol consumption, triglyceride concentration, inflammatory biomarkers, and pre-existing liver disease
Hepatosteatosis was identified based on CT findings rather than liver biopsy
Only liver attenuation was assessed, rather than the difference between liver and spleen attenuation

Resumen

Purpose To assess the association between nonalcoholic fatty liver disease (NAFLD) and quantitative atherosclerotic plaque at CT. Materials and Methods In this post hoc analysis of the prospective Scottish Computed Tomography of the HEART trial (November 2010 to September 2014), hepatosteatosis and coronary artery calcium score were measured at noncontrast CT. Presence of stenoses, visually assessed high-risk plaque, and quantitative plaque burden were assessed at coronary CT angiography. Multivariable models were constructed to assess the impact of hepatosteatosis and cardiovascular risk factors on coronary artery disease. Results Images from 1726 participants (mean age, 58 years ± 9 SD; 974 men) were included. Participants with hepatosteatosis (155 of 1726, 9%) had a higher body mass index, more hypertension and diabetes mellitus, and higher cardiovascular risk scores (P < .001 for all) compared with those without hepatosteatosis. They had increased coronary artery calcium scores (median, 43 Agatston units AU interquartile range, 0–273 vs 19 AU 0–225, P = .046), more nonobstructive disease (48% vs 37%, P = .02), and higher low-attenuation plaque burden (5.11% 0–7.16 vs 4.07% 0–6.84, P = .04). However, these associations were not independent of cardiovascular risk factors. Over a median of 4.7 years, there was no evidence of a difference in myocardial infarction between those with and without hepatosteatosis (1.9% vs 2.4%, P = .92). Conclusion Hepatosteatosis at CT was associated with an increased prevalence of coronary artery disease at CT, but this was not independent of the presence of cardiovascular risk factors. Keywords: CT, Cardiac, Nonalcoholic Fatty Liver Disease, Coronary Artery Disease, Hepatosteatosis, Plaque Quantification Clinical trial registration no. NCT01149590 Supplemental material is available for this article. © RSNA, 2022 See also commentary by Abohashem and Blankstein in this issue.

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