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Prognostic value of pericoronary adipose tissue attenuation in patients with non-alcoholic fatty liver disease with suspected coronary artery disease

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Abstract

Pericoronary adipose tissue (PCAT) attenuation on coronary computed tomography angiography (CTA) has been emerged as a marker of pericoronary inflammation. We aimed to investigate the prognostic value of PCAT attenuation in patients with non-alcoholic fatty liver disease (NAFLD). We enrolled 232 NAFLD patients with suspected coronary artery disease and underwent coronary CTA. NAFLD was defined by abdominal CT as the ratio of hepatic attenuation to spleen attenuation less than 1.0. PCAT attenuation values were assessed by the crude analysis of mean CT attenuation value of the left anterior descending artery (LAD) and right coronary artery (RCA). As coronary CTA findings, luminal stenosis and high-risk plaque features were examined. Primary outcome was the composite of cardiovascular (CV) death, nonfatal acute coronary syndrome, and hospitalization for heart failure. During a median follow-up of 4.9 years, 17 patients had 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 high-risk plaque features was 0.494 (p = 0.041). High-LAD-PCAT attenuation was an independent predictor of CV events in NAFLD patients, regardless of CTA-verified high-risk plaque features. In addition, LAD-PCAT attenuation had an incremental prognostic value over high-risk plaque features.

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Acknowledgements

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Funding

This work was supported by the Japan Society for the Promotion of Science KAKENHI (Grant Number JP 21K16024).

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan

    Keishi Ichikawa, Toru Miyoshi, Mitsutaka Nakashima, Takahiro Nishihara, Takashi Miki, Hironobu Toda, Masatoki Yoshida & Hiroshi Ito

  2. Department of General Internal Medicine 3, Kawasaki Medical School General Medical Center, Okayama, Japan

    Kazuhiro Osawa

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  1. Keishi Ichikawa
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  2. Toru Miyoshi
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Correspondence to Toru Miyoshi.

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This study was conducted according to the principles expressed in the Declaration of Helsinki and was approved by the institutional review board of the Okayama University Graduate School of Medicine. All the enrolled patients provided written informed consent to participate.

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Ichikawa, K., Miyoshi, T., Nakashima, M. et al. Prognostic value of pericoronary adipose tissue attenuation in patients with non-alcoholic fatty liver disease with suspected coronary artery disease. Heart Vessels 37, 1977–1984 (2022). https://doi.org/10.1007/s00380-022-02107-x

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