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: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  NAFLD is associated with advanced high-risk coronary plaque, independent of traditional cardiovascular risk factors and the extent and severity of coronary artery disease.
authors.affiliation: 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.).
authors.forename: Stefan B
authors.initials: SB
authors.lastname: Puchner
authors.forename: Michael T
authors.initials: MT
authors.lastname: Lu
authors.forename: Thomas
authors.initials: T
authors.lastname: Mayrhofer
authors.forename: Ting
authors.initials: T
authors.lastname: Liu
authors.forename: Amit
authors.initials: A
authors.lastname: Pursnani
authors.forename: Brian B
authors.initials: BB
authors.lastname: Ghoshhajra
authors.forename: Quynh A
authors.initials: QA
authors.lastname: Truong
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Wiviott
authors.forename: Jerome L
authors.initials: JL
authors.lastname: Fleg
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Maros
authors.initials: M
authors.lastname: Ferencik
mesh_terms: D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D023921:Coronary Stenosis / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications*; D058226:Plaque, Atherosclerotic / Q000150:complications* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed