Jiang Changqin, Yang Qing, Hou Xueyan, Zhang Mengnan, Yang Zhiqiang, Qin Ruili, Sun Xixia, Tao Xiaoling, Feng Qiang, Wang Zhaoqian
Cardiovascular CT Department. First Hospital Affiliated Dalian Medical University, No. 193, Union Road, Shahekou District, Dalian City, Liaoning Province, Dalian, Liaoning Province, 116021, China.
Radiology Department, Yidu Central Hospital of Shandong Second Medical University, Jiangjunshan Road 5168, Qingzhou, Shandong Province, 262500, China.
BMC Med Imaging. 2025 Sep 29;25(1):398. doi: 10.1186/s12880-025-01919-3.
This study assessed the prognostic value of non-alcoholic fatty liver disease (NAFLD) in predicting major adverse cardiovascular events (MACE) in patients with suspected coronary artery disease (CAD), using coronary computed tomography angiography (CCTA) and CT-derived fractional flow reserve (CT-FFR).
In this retrospective study, patients who underwent both CCTA and non-contrast liver/spleen CT at Dalian Medical University First Affiliated Hospital from January 2017 to December 2018 were included. NAFLD was diagnosed via CT and clinical history. MACE included cardiovascular/cerebrovascular death, all-cause mortality, myocardial infarction, unstable angina hospitalization, unplanned revascularization, and stroke. Patients were divided into NAFLD and non-NAFLD groups. Cox regression assessed the association between NAFLD and MACE, adjusting for cardiovascular risk factors, CCTA findings, and CT-FFR results. Subgroup and time-dependent C-index analyses evaluated prognostic performance across populations and follow-up duration.
Among 2,981 patients (737 with NAFLD), 408 experienced MACE over a median 68-month of follow-up. The NAFLD group had higher CAD-RADS scores, high-risk plaque, coronary calcification, and CT-FFR positivity, all < 0.05. NAFLD independently predicted MACE (adjusted HR: 1.39; 95% CI: 1.15, 1.73; < 0.001), especially in males, smokers, hypertensive and non-diabetic patients, and those with non-obstructive CAD or normal CT-FFR. Including NAFLD improved model performance at all time points, with C-index at 60 months of 0.753 vs. 0.727 (model2) and 0.695 (model 1), < 0.001.
NAFLD serves as an independent prognostic indicator for MACEs in patients with suspected CAD. The incorporation of NAFLD into risk stratification models significantly enhances predictive accuracy, especially within high-risk sub-populations.
The online version contains supplementary material available at 10.1186/s12880-025-01919-3.
本研究利用冠状动脉计算机断层扫描血管造影（CCTA）和CT衍生的血流储备分数（CT-FFR），评估非酒精性脂肪性肝病（NAFLD）在预测疑似冠状动脉疾病（CAD）患者主要不良心血管事件（MACE）中的预后价值。
在这项回顾性研究中，纳入了2017年1月至2018年12月在大连医科大学附属第一医院同时接受CCTA和非增强肝脏/脾脏CT检查的患者。通过CT和临床病史诊断NAFLD。MACE包括心血管/脑血管死亡、全因死亡率、心肌梗死、不稳定型心绞痛住院、非计划血管重建和中风。患者分为NAFLD组和非NAFLD组。Cox回归评估NAFLD与MACE之间的关联，并对心血管危险因素、CCTA结果和CT-FFR结果进行校正。亚组分析和时间依赖性C指数分析评估了不同人群和随访期间的预后性能。
在2981例患者（737例患有NAFLD）中，在中位68个月的随访期间，408例发生了MACE。NAFLD组的CAD-RADS评分、高危斑块、冠状动脉钙化和CT-FFR阳性率更高，均<0.05。NAFLD可独立预测MACE（校正后HR：1.39；95%CI：1.15，1.73；<0.001），尤其是在男性、吸烟者、高血压和非糖尿病患者以及非阻塞性CAD或CT-FFR正常的患者中。纳入NAFLD可在所有时间点改善模型性能，60个月时的C指数为0.753，而模型2为0.727，模型1为0.695，<0.001。
NAFLD是疑似CAD患者MACE的独立预后指标。将NAFLD纳入风险分层模型可显著提高预测准确性，尤其是在高危亚组人群中。
在线版本包含可在10.1186/s12880-025-01919-3获取的补充材料。
