Prognostic value of pericoronary adipose tissue attenuation in patients with non-alcoholic fatty liver disease with suspected coronary artery disease.
Prognostic value of pericoronary adipose tissue attenuation in patients with non-alcoholic fatty liver disease with suspected coronary artery disease.
复制标题
冠状动脉周围脂肪组织衰减对疑似冠状动脉疾病的非酒精性脂肪肝患者的预后价值。
DOI：
10.1007/s00380-022-02107-x
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Hiroshi Ito.
中科院分区：
文献类型：
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作者：
Keishi Ichikawa;Toru Miyoshi;Mitsutaka Nakashima;Takahiro Nishihara;Kazuhiro Osawa;Takashi Miki;Hironobu Toda;Masatoki Yoshida;Hiroshi Ito.
冠状动脉计算机断层扫描血管造影（CTA）上的冠状动脉周围脂肪组织（PCAT）衰减已成为冠状动脉周围炎症的标志物。我们的目的是研究PCAT减弱对非酒精性脂肪肝（NAFLD）患者的预后价值。我们招募了232例疑似冠状动脉疾病的NAFLD患者，并进行了冠状动脉CTA。NAFLD由腹部CT定义为肝脏衰减与脾脏衰减的比值小于1.0。通过对左前降支（LAD）和右冠状动脉（RCA）的平均CT衰减值进行粗略分析来评估PCAT衰减值。作为冠状动脉CTA结果，检查了管腔狭窄和高危斑块特征。主要结局是心血管（CV）死亡、非致死性急性冠脉综合征和因心力衰竭住院的复合终点。在中位随访4.9年期间，17例患者发生CV事件。发生CV事件的患者的LAD-PCAT衰减高于未发生CV事件的患者（−66.9 ± 7.0 vs −70.5 ± 6.6;p= 0.032），而RCA-PCAT衰减则没有。LAD-PCAT衰减和高危斑块特征是CV事件的独立预测因素。将LAD-PCAT衰减添加到高危斑块特征中，将C统计量和总体卡方分别从0.66增加到0.75（p= 0.042）和6.8增加到12.7（p= 0.015）。通过将LAD-PCAT衰减添加到高风险斑块特征实现的净重新分类为0.494（p= 0.041）。高LAD-PCAT衰减是NAFLD患者CV事件的独立预测因子，与CTA证实的高风险斑块特征无关。此外，LAD-PCAT衰减对高风险斑块特征具有增量预后价值。
Pericoronary adipose tissue (PCAT) attenuation on coronary computed tomography angiography (CTA) has been emerged as a marker of pericoronary inflammation. We aimed to investigate the prognostic value of PCAT attenuation in patients with non-alcoholic fatty liver disease (NAFLD). We enrolled 232 NAFLD patients with suspected coronary artery disease and underwent coronary CTA. NAFLD was defined by abdominal CT as the ratio of hepatic attenuation to spleen attenuation less than 1.0. PCAT attenuation values were assessed by the crude analysis of mean CT attenuation value of the left anterior descending artery (LAD) and right coronary artery (RCA). As coronary CTA findings, luminal stenosis and high-risk plaque features were examined. Primary outcome was the composite of cardiovascular (CV) death, nonfatal acute coronary syndrome, and hospitalization for heart failure. During a median follow-up of 4.9 years, 17 patients had CV events. LAD-PCAT attenuation in patients with CV events was higher than that without CV events (−66.9 ± 7.0 versus −70.5 ± 6.6;p= 0.032), while RCA-PCAT attenuation was not. LAD-PCAT attenuation and high-risk plaque features were independent predictors of CV events. The addition of LAD-PCAT attenuation to high-risk plaque features increased the C-statistics and global chi-square from 0.66 to 0.75 (p= 0.042) and 6.8 to 12.7 (p= 0.015), respectively. The net reclassification achieved by adding LAD-PCAT attenuation to high-risk plaque features was 0.494 (p= 0.041). High-LAD-PCAT attenuation was an independent predictor of CV events in NAFLD patients, regardless of CTA-verified high-risk plaque features. In addition, LAD-PCAT attenuation had an incremental prognostic value over high-risk plaque features.