Background

The long-term prognostic value of coronary CT angiography (CCTA) in asymptomatic adults with hepatic steatosis (HS) remains unknown.

Purpose

To evaluate the long-term prognostic value of CCTA in asymptomatic adults with HS.

Materials and Methods

Between January 2009 and December 2013, consecutive asymptomatic adults who underwent CCTA evaluation and unenhanced abdominal CT were prospectively enrolled. All participants were divided into two groups—with HS and without HS according to abdominal CT results. The primary end point was major adverse cardiovascular events (MACEs), defined as cardiac death, stroke, myocardial infarction, and angina requiring hospitalization. Multivariable Cox regression analysis and Kaplan-Meier analysis were used to compare survival rates.

Results

One thousand thirteen participants with HS and 1940 participants without HS who completed the follow-up were included (mean age, 66 years ± 10 [standard deviation] [range, 29–90 years]; 1940 men). During a median of 7.2 years of follow-up (interquartile range, 6.3–8.1), MACEs were observed in 96 of 1013 participants with HS (10%), whereas 80 of 1940 participants without HS (4%) had MACEs. In participants with a Coronary Artery Disease Reporting and Data System (CAD-RADS) category of 0, both participants with and without HS had a similar 8.8-year event-free survival rate (99.2% event-free survival rate in participants with HS vs 99.0% event-free survival rate in participants without HS, P = .77). As for participants with CAD-RADS categories 1 or 2 or 3–5, the 8.8-year event-free survival rate was lower in participants with HS than in those without HS (70.6% vs 85.2%, P < .001; 51.4% vs 71.7%, P = .03, respectively). The risk of MACEs was higher for participants with HS than for those without HS in CAD-RADS categories 1 and 2 (adjusted hazard ratio = 2.3; 95% CI: 1.4, 3.9; P < .001) and CAD-RADS categories 3–5 (adjusted HR = 2.1; 95% CI: 1.2, 3.6; P = .006) but not in the setting of CAD-RADS category 0 (adjusted HR = 5.1; 95% CI: 0.1, 398; P = .47).

Conclusion

Asymptomatic participants with hepatic steatosis (HS) had a worse prognosis than those without HS in the presence of coronary artery disease (CAD) at coronary CT angiography, whereas participants with HS and without CAD might have excellent clinical outcomes during a median follow-up of 7.2 years.

© RSNA, 2021

Online supplemental material is available for this article.

中文翻译：

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无症状肝脂肪变性成人的冠状动脉 CT 血管造影

背景

冠状动脉 CT 血管造影 (CCTA) 对无症状成人肝脂肪变性 (HS) 的长期预后价值仍然未知。

目的

评估 CCTA 对无症状成人 HS 的长期预后价值。

材料和方法

2009 年 1 月至 2013 年 12 月期间，连续入组接受 CCTA 评估和腹部平扫 CT 的无症状成人。所有参与者根据腹部 CT 结果分为两组 - 有 HS 和没有 HS。主要终点是主要不良心血管事件 (MACE)，定义为心源性死亡、中风、心肌梗死和需要住院治疗的心绞痛。多变量Cox回归分析和Kaplan-Meier分析用于比较存活率。

结果

包括 1,013 名完成随访的 HS 参与者和 1940 名未患 HS 的参与者（平均年龄，66 岁 ± 10 [标准差] [范围，29-90 岁]；1940 名男性）。在中位 7.2 年的随访期间（四分位距，6.3-8.1），1013 名 HS 参与者中有 96 名（10%）观察到 MACE，而 1940 名无 HS 参与者中有 80 名（4%）出现 MACE。在冠状动脉疾病报告和数据系统 (CAD-RADS) 类别为 0 的参与者中，有和没有 HS 的参与者具有相似的 8.8 年无事件生存率（HS 参与者的 99.2% 无事件生存率 vs 99.0% 无 HS 参与者的无事件生存率，P= .77）。对于 CAD-RADS 1 级或 2 级或 3-5 级的参与者，HS 参与者的 8.8 年无事件生存率低于非 HS 参与者（70.6% 对 85.2%，P < .001；51.4%与 71.7% ，分别为P = .03）。在 CAD-RADS 类别 1 和 2（调整后的风险比 = 2.3；95% CI：1.4、3.9；P < .001）和 CAD-RADS 类别 3– 中，患有 HS 的参与者发生 MACEs 的风险高于没有 HS 的参与者5（调整后的 HR = 2.1；95% CI：1.2、3.6 ；P = .006）但不在 CAD-RADS 类别 0 的设置中（调整后的 HR = 5.1；95% CI：0.1、398；P = .47） .

结论

在冠状动脉 CT 血管造影中存在冠状动脉疾病 (CAD) 的无症状肝脂肪变性 (HS) 参与者的预后比没有 HS 的参与者更差，而患有 HS 且没有 CAD 的参与者在7.2 年。

©北美放射学会，2021

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