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, 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

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    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.

    Original languageEnglish (US)
    Pages (from-to)693-701
    Number of pages9
    JournalRadiology
    Volume274
    Issue number3
    DOIs
    StatePublished - Mar 1 2015

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    Coronary Stenosis
    Angiography
    Coronary Artery Disease
    Calcium
    Non-alcoholic Fatty Liver Disease
    Ethics Committees
    Liver
    Atherosclerotic Plaques
    Informed Consent
    Liver Cirrhosis
    Contrast Media
    Alcoholism
    Liver Diseases
    Pathologic Constriction
    Spleen
    Logistic Models
    Odds Ratio
    Myocardial Infarction
    Tomography
    Regression Analysis

    ASJC Scopus subject areas

    • Radiology Nuclear Medicine and imaging
    • Medicine(all)

    Cite this

    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. / 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.

    In: Radiology, Vol. 274, No. 3, 01.03.2015, p. 693-701.

    Research output: Contribution to journalArticle

    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. / 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. In: Radiology. 2015 ; Vol. 274, No. 3. pp. 693-701.
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    title = "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",
    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.",
    author = "Puchner, {Stefan B.} and Lu, {Michael T.} and Thomas Mayrhofer and Ting Liu and Amit Pursnani and Ghoshhajra, {Brian B.} and Truong, {Quynh A.} and Wiviott, {Stephen D.} and Fleg, {Jerome L.} and Udo Hoffmann and Maros Ferencik",
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    T1 - High-Risk coronary plaque at coronary CT angiography is associated with nonalcoholic fatty liver disease, independent of coronary plaque and stenosis burden

    T2 - Results from the ROMICAT II Trial

    AU - Puchner, Stefan B.

    AU - Lu, Michael T.

    AU - Mayrhofer, Thomas

    AU - Liu, Ting

    AU - Pursnani, Amit

    AU - Ghoshhajra, Brian B.

    AU - Truong, Quynh A.

    AU - Wiviott, Stephen D.

    AU - Fleg, Jerome L.

    AU - Hoffmann, Udo

    AU - Ferencik, Maros

    PY - 2015/3/1

    Y1 - 2015/3/1

    N2 - 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.

    AB - 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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