AIMS This study aimed to investigate additional risk stratification benefits of hepatic steatosis (HS) concurrently assessed during coronary computed tomography angiography (CTA) in a large patient cohort with suspected stable coronary artery disease (CAD). METHODS AND RESULTS In this prospective study, 1148 Japanese outpatients without a history of CAD who underwent coronary CTA for suspected stable CAD (mean age 64 ± 14 years) were included. HS, defined on CT as a hepatic-to-spleen attenuation ratio of <1.0, was examined just before the evaluation of adverse CTA findings, defined as obstructive and/or high-risk plaque. The major adverse cardiac events (MACE) were the composite of cardiac death, acute coronary syndrome, and late revascularization. The incremental predictive value of HS was evaluated using the global χ2 test and C-statistic. HS was identified in 247 (22%) patients. During a median follow-up of 3.9 years, MACE was observed in 40 (3.5%) patients. HS was significantly associated with MACE in a model that included adverse CTA findings (hazard ratio 4.01, 95% confidence interval 2.12-7.59, P < 0.001). By adding HS to the Framingham risk score and adverse CTA findings, the global χ2 score and C-statistic significantly increased from 29.0 to 49.5 (P < 0.001) and 0.74 to 0.81 (P = 0.026), respectively. In subgroup analyses in patients with diabetes mellitus and metabolic syndrome, HS had significant additive predictive value for MACE over the Framingham risk score and adverse CTA findings. CONCLUSION In patients with suspected stable CAD, concurrent evaluation of HS during coronary CTA enables more accurate detection of patients at higher risk of MACE.

中文翻译：

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在疑似冠状动脉疾病的患者中，非酒精性脂肪性肝病的预后价值超过冠状动脉计算机断层扫描血管造影结果。

目的 本研究旨在调查在疑似稳定型冠状动脉疾病 (CAD) 的大型患者队列中，在冠状动脉计算机断层扫描血管造影 (CTA) 期间同时评估的肝脂肪变性 (HS) 的额外风险分层益处。方法和结果 在这项前瞻性研究中，纳入了 1148 名没有 CAD 病史的日本门诊患者，他们因疑似稳定型 CAD（平均年龄 64 ± 14 岁）接受了冠状动脉 CTA。HS，在 CT 上定义为肝脾衰减比<1.0，在评估不良 CTA 发现之前检查，定义为阻塞性和/或高风险斑块。主要不良心脏事件（MACE）是心源性死亡、急性冠状动脉综合征和晚期血运重建的复合事件。使用全局 χ2 检验和 C 统计量评估 HS 的增量预测值。在 247 名 (22%) 患者中发现了 HS。在 3.9 年的中位随访期间，40 名 (3.5%) 患者出现 MACE。在包含不利 CTA 发现的模型中，HS 与 MACE 显着相关（风险比 4.01，95% 置信区间 2.12-7.59，P < 0.001）。通过将 HS 添加到 Framingham 风险评分和不良 CTA 发现，整体 χ2 评分和 C 统计量分别从 29.0 显着增加到 49.5（P < 0.001）和 0.74 到 0.81（P = 0.026）。在糖尿病和代谢综合征患者的亚组分析中，与 Framingham 风险评分和不良 CTA 结果相比，HS 对 MACE 具有显着的附加预测价值。结论 在疑似稳定型 CAD 患者中，在冠状动脉 CTA 期间同时评估 HS 可以更准确地检测出 MACE 风险较高的患者。