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The Prevalence of Hepatic Steatosis in Patients With Normal Coronary Computed Tomography Angiography: Is It Time for
Marc T Zughaib1, Chad Nicholson2, Vincent Lipari3
1Cardiology, Ascension Providence Hospital - Michigan State University College of Human Medicine (MSUCHM), Southfield, USA.
Insights
Normal coronary computed tomography angiography (CCTA) scans may still indicate cardiovascular risk if hepatic steatosis is present. This common finding on CCTA suggests a higher risk of atherosclerosis, even with a zero calcium score.
Area of Science:
- Cardiovascular Imaging and Diagnostics
- Radiology
- Hepatic and Cardiovascular Health
Background:
- Coronary computed tomography angiography (CCTA) is increasingly used to assess cardiovascular risk.
- Normal CCTA findings typically reclassify patients to a lower risk category.
- Hepatic steatosis, detectable on CCTA, is linked to adverse cardiovascular outcomes.
Purpose of the Study:
- To determine the prevalence of hepatic steatosis in patients with normal CCTA results.
- To investigate the clinical significance of hepatic steatosis in individuals with a zero coronary calcium score.
Main Methods:
- Retrospective, single-center analysis of 99 patients with a coronary calcium score of zero.
- Non-contrast CCTA images were used to identify hepatic steatosis based on liver-to-spleen attenuation (Hounsfield units).
- Patients with non-calcified plaque were excluded, leaving 89 for analysis.
Main Results:
- Of 89 patients with normal CCTAs (zero calcium score and no non-calcified plaque), 13 (14%) showed evidence of hepatic steatosis.
- Hepatic steatosis was identified using liver attenuation measurements compared to the spleen.
- This indicates a significant prevalence of hepatic steatosis in patients with seemingly normal coronary arteries.
Conclusions:
- Hepatic steatosis is present in a notable proportion (14%) of patients with normal CCTAs.
- Identifying hepatic steatosis in these patients is clinically important, as it signifies a higher underlying cardiovascular risk.
- This finding challenges the assumption of low cardiovascular risk solely based on normal CCTA, highlighting the prognostic value of evaluating hepatic steatosis.
Abstract:
The role of coronary computed tomography angiography (CCTA) in diagnostic cardiology is steadily increasing. Normal CCTAs successfully reclassify patients to a low-to-intermediate risk category with marked reduction in cardiovascular events. However, hepatic steatosis has been associated with adverse cardiovascular events and can be routinely evaluated on non-contrast CCTAs. The prevalence of hepatic steatosis in the setting of normal CCTAs is not known and may be of clinical significance. We conducted a retrospective, single-center analysis to evaluate for the presence and incidence of hepatic steatosis in the setting of normal CCTAs. Non-contrast images were used to identify/measure the presence or absence of hepatic steatosis. The presence of hepatic steatosis was defined based on attenuation measurements in Hounsfield units (HU), by comparing the liver and spleen. Of 297 patients screened, a cohort of 99 patients were identified with a coronary calcium score of zero. Ten patients (10%) were found to have non-calcified plaque on CCTA and were excluded from the study population. Of the remaining 89 patients, 13 patients (14%) were found to have evidence of hepatic steatosis. Patients with normal CCTAs are often reassured, supported by data predicting an improved prognosis with low rates of cardiovascular events. We propose that evaluating and identifying patients with underlying hepatic steatosis, a known associated marker of atherosclerosis, even in patients with "normal" CCTAs is important, as this correlates with higher cardiovascular risk.
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