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Clinical Trial
. 2015 Mar;274(3):693-701.
doi: 10.1148/radiol.14140933. Epub 2014 Nov 4.

High-risk coronary plaque at coronary CT angiography is associated with nonalcoholic fatty liver disease, independent of coronary plaque and stenosis burden: results from the ROMICAT II trial

Stefan B Puchner  1 , Michael T Lu, Thomas Mayrhofer, Ting Liu, Amit Pursnani, Brian B Ghoshhajra, Quynh A Truong, Stephen D Wiviott, Jerome L Fleg, Udo Hoffmann, Maros Ferencik
Affiliations
Clinical Trial

High-risk coronary plaque at coronary CT angiography is associated with nonalcoholic fatty liver disease, independent of coronary plaque and stenosis burden: results from the ROMICAT II trial

Stefan B Puchner et al. Radiology. 2015 Mar.

Abstract

Purpose: To determine the association between nonalcoholic fatty liver disease (NAFLD) and the presence of high-risk coronary atherosclerotic plaque as assessed with coronary computed tomographic (CT) angiography.

Materials and methods: This study was approved by the local ethics committees; informed consent was obtained. Patients randomized to the coronary CT angiography arm of the Rule Out Myocardial Infarction using Computer Assisted Tomography, or ROMICAT, II trial who underwent both nonenhanced CT to assess calcium score and contrast material-enhanced coronary CT angiography were included. Readers assessed coronary CT angiography images for the presence of coronary plaque, significant stenosis (≥50%), and high-risk plaque features (positive remodeling, CT attenuation < 30 HU, napkin-ring sign, spotty calcium). NAFLD was defined as hepatic steatosis at nonenhanced CT (liver minus spleen CT attenuation < 1 HU) without evidence of clinical liver disease, liver cirrhosis, or alcohol abuse. To determine the association between high-risk plaque and NAFLD, univariable and multivariable logistic regression analyses were performed, with high-risk plaque as a dependent variable and NAFLD, traditional risk factors, and extent of coronary atherosclerosis as independent variables.

Results: Overall, 182 (40.9%) of 445 patients had CT evidence of NAFLD. High-risk plaque was more frequent in patients with NAFLD than in patients without NAFLD (59.3% vs 19.0%, respectively; P < .001). The association between NAFLD and high-risk plaque (odds ratio, 2.13; 95% confidence interval: 1.18, 3.85) persisted after adjusting for the extent and severity of coronary atherosclerosis and traditional risk factors.

Conclusion: NAFLD is associated with advanced high-risk coronary plaque, independent of traditional cardiovascular risk factors and the extent and severity of coronary artery disease.

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Figures

Figure 1:
Figure 1:
Flowchart demonstrates study population enrollment, both exclusion and inclusion. CCTA = coronary CT angiography.
Figure 2:
Figure 2:
Coronary CT angiography images demonstrate examples of high-risk plaque features. A, Image was obtained in a 63-year-old man with partially calcified plaque, positive remodeling (vertical arrow), and spotty calcium (horizontal arrow). B, A cross-sectional view of a noncalcified plaque in a 65-year-old man demonstrates a napkin-ring sign with a central low-attenuation area, surrounded by a peripheral rim of higher attenuation (arrow) next to the lumen (*). C, Image in a 60-year-old woman with partially calcified plaque demonstrates a low CT number in the midportion (arrow).
Figure 3:
Figure 3:
Axial nonenhanced CT image in a 62-year-old man demonstrates attenuation measurements of the liver and spleen. Image shows a diffuse fat accumulation in the liver, with a mean liver attenuation of 32.5 HU and a mean spleen attenuation of 46.2 HU.
Figure 4:
Figure 4:
Bar graph demonstrates high-risk plaque features stratified according to presence or absence of NAFLD.
See this image and copyright information in PMC

References

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