Coronary CTA Sign Predicts CV Event Risk in Nonalcoholic Fatty Liver Disease

Melissa Nelson

February 07, 2022

The study covered in this summary was published in ResearchSquare as a preprint and has not yet been peer-reviewed.

Key Takeaway

  • High left anterior descending artery pericoronary adipose tissue (LAD-PCAT) attenuation at coronary CT angiography (CTA) was found to be prognostic for cardiovascular (CV) events over 5 or more years in patients with nonalcoholic fatty liver disease (NAFLD).

Why This Matters 

  • NAFLD is growing in prevalence, and patients with NAFLD are at increased risk for CV disease. Prevention of CV events in patients with NAFLD should be considered an important public health goal.

  • This might be the first study to show an association between increased LAD-PCAT attenuation and risk for CV events in patients with NAFLD. It suggests that concurrent assessment of PCAT attenuation during coronary CTA could be helpful in identifying patients with NAFLD who are at increased risk for future CV events.

Study Design 

  • Data from a prospective cohort study were used post hoc to assess PCAT attenuation and investigate the association between NAFLD and coronary artery disease (CAD) prognosis.

  • The study population consisted of 232 adults with NAFLD who underwent coronary CTA for suspected CAD. Data were collected between August 2011 and December 2016.

  • All patients also underwent noncontrast CT imaging for evaluation of hepatic steatosis immediately prior to CV imaging. Hepatic and splenic Hounsfield-unit (HU) attenuations were measured, and an NAFLD diagnosis was defined as a liver-to-spleen ratio below 1.0. Fibrosis-4 index score was used to estimate the extent of liver fibrosis.

Key Results 

  • LAD-PCAT attenuation was significantly higher in patients who went on to experience CV events than in those without CV events (66.9 ±7.0 vs −70.5 ± 6.6 HU; P = .032).

  • After adjustment for high-risk plaque features, LAD-PCAT attenuation independently predicted CV events over a median follow-up of 4.9 years (hazard ratio, 3.32; 95% CI, 1.28 - 8.63; = .014).

  • Addition of LAD-PCAT attenuation to high-risk plaque features raised the C-statistics and global chi-square from 0.66 to 0.75 (P = .042) for predicting CV risk.


  • The small sample size drawn from a single-center population limits application to a broader population of patients with NAFLD.

  • NAFLD was diagnosed by abdominal CT without histologic confirmation, which is the disorder's diagnostic gold standard.

  • Only patients with NAFLD and suspected CAD were included, leaving open the possibility of selection bias.

Study Disclosures

  • This study was supported by the Japan Society for the Promotion of Science KAKEHNHI (Grants-in-Aid for Scientific Research)

  • All authors report no conflicts of interest.

This is a summary of a preprint research study, Prognostic Value of Pericoronary Adipose Tissue Attenuation in Patients With Non-alcoholic Fatty Liver Disease With Suspected Coronary Artery Disease, from Toru Miyoshi and colleagues from Okayama University, Okayama Daigaku, Japan, on ResearchSquare provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on ResearchSquare.


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