Puchner Stefan B, Lu Michael T, Mayrhofer Thomas, Liu Ting, Pursnani Amit, Ghoshhajra Brian B, Truong Quynh A, Wiviott Stephen D, Fleg Jerome L, Hoffmann Udo, Ferencik Maros
From the Department of Radiology (S.B.P., M.T.L., T.M., T.L., A.P., B.B.G., Q.A.T., U.H., M.F.), Cardiac MR PET CT Program (S.B.P., M.T.L., T.M., T.L., A.P., B.B.G., Q.A.T., U.H., M.F.), and Cardiology Division (Q.A.T., M.F.), Massachusetts General Hospital and Harvard Medical School, 165 Cambridge St, Suite 400, Boston, MA 02114; Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (S.B.P.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.D.W.); and Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, Md (J.L.F.).
Radiology. 2015 Mar;274(3):693-701. doi: 10.1148/radiol.14140933. Epub 2014 Nov 4.
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.
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.
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.
NAFLD is associated with advanced high-risk coronary plaque, independent of traditional cardiovascular risk factors and the extent and severity of coronary artery disease.
通过冠状动脉计算机断层扫描（CT）血管造影评估非酒精性脂肪性肝病（NAFLD）与高危冠状动脉粥样硬化斑块存在之间的关联。
本研究经当地伦理委员会批准；获得了知情同意。纳入随机分配至使用计算机辅助断层扫描排除心肌梗死（ROMICAT）II试验冠状动脉CT血管造影组的患者，这些患者接受了非增强CT以评估钙化积分以及对比剂增强冠状动脉CT血管造影。阅片者评估冠状动脉CT血管造影图像，以确定是否存在冠状动脉斑块、显著狭窄（≥50%）以及高危斑块特征（正性重构、CT衰减<30 HU、餐巾环征、斑点状钙化）。NAFLD定义为非增强CT显示肝脂肪变性（肝脏减去脾脏CT衰减<1 HU），且无临床肝病、肝硬化或酒精滥用的证据。为确定高危斑块与NAFLD之间的关联，进行了单变量和多变量逻辑回归分析，以高危斑块作为因变量，NAFLD、传统危险因素以及冠状动脉粥样硬化程度作为自变量。
总体而言，445例患者中有182例（40.9%）有NAFLD的CT证据。NAFLD患者中高危斑块的发生率高于无NAFLD的患者（分别为59.3%和19.0%；P<.001）。在调整冠状动脉粥样硬化的程度和严重程度以及传统危险因素后，NAFLD与高危斑块之间的关联（比值比，2.13；95%置信区间：1.18，3.85）仍然存在。
NAFLD与晚期高危冠状动脉斑块相关，独立于传统心血管危险因素以及冠状动脉疾病的程度和严重程度。
