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

Purpose: Pericoronary adipose tissue (PCAT) attenuation on coronary computed tomography angiography (CTA) has emerged as a marker for pericoronary inflammation. We investigated the prognostic value of PCAT attenuation in patients with non-alcoholic fatty liver disease (NAFLD). Methods: We enrolled 232 patients with NAFLD and suspected coronary artery disease who underwent coronary CTA. NAFLD was defined by abdominal computed tomography (CT) as a ratio of hepatic attenuation to spleen attenuation of <1.0. PCAT attenuation values were assessed by crude analysis of the mean CT attenuation values of the left anterior descending artery (LAD) and right coronary artery (RCA). Luminal stenosis and high-risk plaque features were examined as coronary CTA findings. The primary outcome was a composite of cardiovascular (CV) death, nonfatal acute coronary syndrome, and hospitalization for heart failure. Results: During a median follow-up of 4.9 years, 17 patients experienced CV events. LAD-PCAT attenuation in patients with CV events was higher than that without CV events (−66.9±7.0 versus −70.5±6.6; p=0.032), while RCA-PCAT attenuation was not. LAD-PCAT attenuation and high-risk plaque features were independent predictors of CV events. The addition of LAD-PCAT attenuation to high-risk plaque features increased the C-statistics and global chi-square from 0.66 to 0.75 (p=0.042) and 6.8 to 12.7 (p=0.015), respectively. The net reclassification achieved by adding LAD-PCAT attenuation to the high-risk plaque features was 0.494 (p=0.041). Conclusion: High LAD-PCAT attenuation was an independent predictor of CV events in patients with NAFLD regardless of CTA-verified high-risk plaque features. Additionally, LAD-PCAT attenuation had incremental prognostic value over high-risk plaque features.