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Coronary computed tomography angiography (CCTA)–extracted pericoronary fat attenuation index (FAI) is an emerging, noninvasive imaging biomarker that quantitatively reflects coronary artery inflammation.
Coronary inflammation quantified by CCTA-derived fat attenuation index mediates 46.8% of the link between MAFLD and MACE.
Coronary computed tomography angiography (CCTA)–extracted pericoronary fat attenuation index (FAI) is an emerging, noninvasive imaging biomarker that quantitatively reflects coronary artery inflammation. While metabolic dysfunction–associated fatty liver disease (MAFLD) is increasingly recognized as a major cardiometabolic risk factor, it remains unclear whether coronary inflammation measured by FAI mediates the connection between MAFLD and major adverse cardiovascular events (MACE). This study sought to explore the link of MAFLD with CCTA-derived plaque characteristics and cardiovascular (CV) events.
Patients presenting with stable chest pain who underwent both CCTA and unenhanced abdominal CT were prospectively enrolled. Based on abdominal CT findings, 367 participants were categorized into MAFLD (n=135) and non-MAFLD (n=232) groups. The key clinical outcome was MACEs occurrence, defined as:
Multivariable logistic regression and survival analyses were executed after adjustment for traditional CV risk factors.
After adjustment for conventional risk factors, MAFLD was independently linked with:
Over a 36-month follow-up period, patients with MAFLD illustrated markedly lower MACE-free survival compared to those without MAFLD (54.0% vs. 83.5%). MAFLD was independently associated with a markedly increased risk of MACEs (hazard ratio = 3.65). Importantly, mediation analysis showed that FAI accounted for 46.8% of the connection between MAFLD and MACEs, highlighting coronary inflammation as a key mechanistic link.
MAFLD was strongly linked with adverse coronary plaque characteristics, including structural, functional, and inflammatory abnormalities detected by CCTA. Coronary inflammation, quantified by pericoronary FAI, partially mediates the link between MAFLD and MACE. These findings emphasize the importance of integrating CV imaging biomarkers, fatty liver disease assessment, and inflammatory risk profiling to boost CV risk prediction and prevention strategies in MAFLD.
BMC Medical Imaging
Association of metabolic dysfunction–associated fatty liver disease with coronary CT angiography-derived plaque characteristics and cardiovascular events
Jin-jin Wang et al.
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