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Plaque progression at coronary CT angiography links non-alcoholic fatty liver disease and cardiovascular events: a prospective single-center study

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Abstract

Objectives

The presence of non-alcoholic fatty liver disease (NAFLD) has been associated with major adverse cardiovascular events (MACEs); however, the mechanisms that initiate the risk for MACEs in patients with NAFLD remain unknown. We sought to investigate whether plaque progression (PP), determined by coronary CT angiography (CCTA), moderate the relationship between NAFLD and MACEs.

Methods

A total of 1683 asymptomatic participants (mean age, 63.3 ± 9.4 [range, 38–85] years; 1117 men) who underwent baseline and follow-up CCTA examination were prospectively included in our study. All of the participants were divided into the NAFLD and non-NAFLD groups. PP was determined by follow-up CCTA. The primary endpoint was MACEs, defined as the composite of all-cause death, nonfatal myocardial infarction, and unplanned hospitalization for acute coronary syndrome leading to revascularization.

Results

At follow-up CCTA, participants with NAFLD showed higher incidence of PP than those without [33.0% (248/752) vs. 16.6% (155/931), p < 0.001]. Compared with non-NAFLD participants, participants with NAFLD had a lower 9.7-year event-free survival rate (80.9 vs. 66.4%, log-rank p < 0.001). Cox regression analysis revealed NAFLD was significantly associated with MACEs (HR = 1.63, 95% CI: 1.28 to 2.06, p < 0.001) after adjusting for covariables. However, this association was no longer significant after adjustment for PP (HR = 1.10, 95% CI: 0.84 to 1.45, p = 0.496). The mediation analysis revealed that PP had a significant indirect effect (β = 0.0587, 95% CI: 0.0424 to 0.08, p < 0.001) and mediated 99.8% (p = 0.002) for the relationship between NAFLD and MACEs.

Conclusions

Plaque progression, identified by follow-up CCTA, mediates the relationship between NAFLD and MACEs.

Key Points

  • The incidence of CCTA–identified PP was higher for participants with NAFLD than those without NAFLD (248/752 [33.0%] vs. 155/931 [16.6%], p < 0.001).

  • Participants with NAFLD had a lower 9.7-year event-free survival rate than those without NAFLD (66.4% vs. 80.9%, log-rank p < 0.001).

  • The mediation analysis revealed that PP had a significant indirect effect (β = 0.0587, 95% CI: 0.0424 to 0.08, p < 0.001) and mediated 99.8% (p = 0.002) for the relationship between NAFLD and MACEs.

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Abbreviations

CAD:

Coronary artery disease

CAD-RADS:

Coronary Artery Disease Reporting and Data System

CCTA:

Coronary CT angiography

CI:

Confidence interval

CPV:

Calcified plaque volume

CVD:

Cardiovascular disease

HR:

Hazard ratio

ICC:

Intra-class correlation coefficients

MACEs:

Major adverse cardiovascular events

NAFLD:

Non-alcoholic fatty liver disease

NCPV:

Non-calcified plaque volume

NCV:

Necrotic core volume

PCI:

Percutaneous coronary intervention

PP:

Plaque progression

TPV:

Total plaque volume

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Funding

This study is supported by the National Natural Science Foundation of China (Grant No.: 82102033), Shanghai Sailing Program (Grant No.: 20YF1435900), Zhongshan Hospital Fudan University Science Foundation for Youth (Grant No.: 2021ZSQN03), Shanghai Municipal Key Clinical Specialty (Grant No.: shslczdzk03202) and Shanghai Clinical Research Center for Interventional Medicine (Grant No.: 19MC1910300).

Author information

Author notes

  1. Meng-Meng Yu, Xiang-Lin Tang and Xin Zhao contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China

    Meng-Meng Yu, Yin-Yin Chen & Meng-Su Zeng

  2. Department of Cardiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Cardiovascular Diseases; National Clinical Research Center for Interventional Medicine, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China

    Xiang-Lin Tang, Xin Zhao & Qi-Bing Wang

  3. Siemens Healthineers CT Collaboration, No. 399, West Haiyang Road, Shanghai, 200126, China

    Zhi-Han Xu

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  1. Meng-Meng Yu
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Corresponding author

Correspondence to Meng-Su Zeng.

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Guarantor

The scientific guarantor of this publication is Meng-Su Zeng.

Conflict of interest

Zhi-Han Xu, MD, is an employee of Siemens Healthineers. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all participants in this study.

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Institutional Review Board approval was obtained.

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• Performed at one institution

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Yu, MM., Tang, XL., Zhao, X. et al. Plaque progression at coronary CT angiography links non-alcoholic fatty liver disease and cardiovascular events: a prospective single-center study. Eur Radiol 32, 8111–8121 (2022). https://doi.org/10.1007/s00330-022-08904-2

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  • DOI: https://doi.org/10.1007/s00330-022-08904-2

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