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Association between Nonalcoholic Fatty Liver Disease at CT and Coronary Microvascular Dysfunction at Myocardial
Tomas Vita1, David J Murphy1, Michael T Osborne1
1From the Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology (T.V., D.J.M., M.T.O., N.S.B., A.K., A.J.D.M., P.B., J.H., C.F.B., M.L.S., V.R.T., H.S., R.B., M.F.D.C., S.D.), Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (S.J., A.N., J.H., C.F.B., V.R.T., M.F.D.C., S.D.), and Cardiovascular Division (V.R.T., H.S., R.B., M.F.D.C., S.D.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; Department of Radiology, St Vincent's University Hospital, Dublin, Ireland (D.J.M.); Cardiac MR/PET/CT Program, Departments of Medicine and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.T.O.); and Division of Cardiology, Department of Internal Medicine and Radiology, University of Alabama at Birmingham, Birmingham, Ala (N.S.B.).
Insights
Nonalcoholic fatty liver disease (NAFLD) is linked to more frequent coronary microvascular dysfunction. This dysfunction independently predicts major adverse cardiac events (MACE), even without NAFLD.
Area of Science:
- Cardiology
- Hepatology
- Medical Imaging
Background:
- Cardiovascular disease is a leading cause of mortality in nonalcoholic fatty liver disease (NAFLD) patients.
- The relationship between NAFLD and coronary microvascular dysfunction (CMD) is not well understood.
Purpose of the Study:
- To investigate the prevalence of CMD in NAFLD patients.
- To determine if CMD predicts major adverse cardiac events (MACE) independently of NAFLD.
Main Methods:
- Retrospective study of 886 patients without obstructive coronary artery disease.
- NAFLD diagnosed via CT hepatic attenuation (<40 HU); CMD defined by coronary flow reserve (CFR) (<2.0).
- Myocardial perfusion PET/CT used for assessment; MACE defined as composite of mortality, MI, revascularization, heart failure hospitalization.
Main Results:
- NAFLD patients (14.1%) showed higher prevalence of CMD (64.8% vs 43.4%, P < .001) and lower CFR (1.9 vs 2.2, P < .001).
- NAFLD independently predicted CMD (P = .01).
- CMD remained associated with MACE (aHR, 1.46; P = .04), and NAFLD-male sex interaction predicted MACE (HR, 1.45; P = .008).
Conclusions:
- Coronary microvascular dysfunction is more prevalent in patients with NAFLD.
- CMD is an independent predictor of MACE in this population.
Abstract:
Background Cardiovascular disease is a major cause of mortality in patients with nonalcoholic fatty liver disease (NAFLD). However, the association of NAFLD with coronary microvascular dysfunction is, to our knowledge, unknown. Purpose To determine whether coronary microvascular dysfunction is more prevalent in patients with NAFLD and to determine whether coronary microvascular dysfunction predicts major adverse cardiac events (MACE) independently of NAFLD. Materials and Methods This retrospective study (2006-2014) included patients without evidence of obstructive epicardial coronary artery disease and healthy left ventricular ejection fraction (≥40%) at a clinical rest and stress myocardial perfusion PET/CT. NAFLD was defined by a mean hepatic attenuation of less than 40 HU at CT and coronary microvascular dysfunction as a coronary flow reserve (CFR) of less than 2.0. A composite of all-cause mortality, myocardial infarction, coronary revascularization, and hospitalization because of heart failure comprised MACE (130 of 886 patients; 14.7%). The relation between NAFLD and MACE was assessed by using multivariable Cox regression analysis. Results Among 886 patients (mean age, 62 years ± 12 [standard deviation]; 631 women [mean age, 62 years ± 12 years] and 255 men [mean age, 61 years ± 12]; and ejection fraction, 63% ± 9), 125 patients (14.1%) had NAFLD and 411 patients (46.4%) had coronary microvascular dysfunction. Coronary microvascular dysfunction was more prevalent (64.8% vs 43.4%; P < .001) and CFR was lower (1.9 ± 1.1 vs 2.2 ± 0.7; P < .001) in patients with NAFLD compared with those without NAFLD. NAFLD independently predicted coronary microvascular dysfunction (P = .01). The interaction of NAFLD and male sex predicted MACE (hazard ratio, 1.45; 95% confidence interval: 1.08, 1.69; P = .008) and coronary microvascular dysfunction remained associated with MACE (adjusted hazard ratio, 1.46; 95% confidence interval: 1.02, 2.07; P = .04). Conclusion Coronary microvascular dysfunction was more prevalent in patients with nonalcoholic fatty liver disease and predicted major adverse cardiac events independently of nonalcoholic fatty liver disease. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Ambale-Venkatesh and Lima in this issue.
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