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Lin, Andrew; Wong, Nathan D.; Razipour, Aryabod; McElhinney, Priscilla A.; Commandeur, Frederic; Cadet, Sebastien J.; Gransar, Heidi; Chen, Xi; Cantu, Stephanie; Miller, Robert J. H.; Nerlekar, Nitesh; Wong, Dennis T. L.; Slomka, Piotr J.; Rozanski, Alan; Tamarappoo, Balaji K.; Berman, Daniel S.; Dey, Damini

Metabolic syndrome, fatty liver, and artificial intelligence-based epicardial adipose tissue measures predict long-term risk of cardiac events: a prospective study

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  • Media type: E-Article
  • Title: Metabolic syndrome, fatty liver, and artificial intelligence-based epicardial adipose tissue measures predict long-term risk of cardiac events: a prospective study
  • Contributor: Lin, Andrew; Wong, Nathan D.; Razipour, Aryabod; McElhinney, Priscilla A.; Commandeur, Frederic; Cadet, Sebastien J.; Gransar, Heidi; Chen, Xi; Cantu, Stephanie; Miller, Robert J. H.; Nerlekar, Nitesh; Wong, Dennis T. L.; Slomka, Piotr J.; Rozanski, Alan; Tamarappoo, Balaji K.; Berman, Daniel S.; Dey, Damini
  • imprint: Springer Science and Business Media LLC, 2021
  • Published in: Cardiovascular Diabetology, 20 (2021) 1
  • Language: English
  • DOI: 10.1186/s12933-021-01220-x
  • ISSN: 1475-2840
  • Origination:
  • Footnote:
  • Description: <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>We sought to evaluate the association of metabolic syndrome (MetS) and computed tomography (CT)-derived cardiometabolic biomarkers (non-alcoholic fatty liver disease [NAFLD] and epicardial adipose tissue [EAT] measures) with long-term risk of major adverse cardiovascular events (MACE) in asymptomatic individuals.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>This was a post-hoc analysis of the prospective EISNER (Early-Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) study of participants who underwent baseline coronary artery calcium (CAC) scoring CT and 14-year follow-up for MACE (myocardial infarction, late revascularization, or cardiac death). EAT volume (cm<jats:sup>3</jats:sup>) and attenuation (Hounsfield units [HU]) were quantified from CT using fully automated deep learning software (&lt; 30 s per case). NAFLD was defined as liver-to-spleen attenuation ratio &lt; 1.0 and/or average liver attenuation &lt; 40 HU.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>In the final population of 2068 participants (59% males, 56 ± 9 years), those with MetS (n = 280;13.5%) had a greater prevalence of NAFLD (26.0% vs. 9.9%), higher EAT volume (114.1 cm<jats:sup>3</jats:sup> vs. 73.7 cm<jats:sup>3</jats:sup>), and lower EAT attenuation (−76.9 HU vs. −73.4 HU; all p &lt; 0.001) compared to those without MetS. At 14 ± 3 years, MACE occurred in 223 (10.8%) participants. In multivariable Cox regression, MetS was associated with increased risk of MACE (HR 1.58 [95% CI 1.10–2.27], p = 0.01) independently of CAC score; however, not after adjustment for EAT measures (p = 0.27). In a separate Cox analysis, NAFLD predicted MACE (HR 1.78 [95% CI 1.21–2.61], p = 0.003) independently of MetS, CAC score, and EAT measures. Addition of EAT volume to current risk assessment tools resulted in significant net reclassification improvement for MACE (22% over ASCVD risk score; 17% over ASCVD risk score plus CAC score).</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>MetS, NAFLD, and artificial intelligence-based EAT measures predict long-term MACE risk in asymptomatic individuals. Imaging biomarkers of cardiometabolic disease have the potential for integration into routine reporting of CAC scoring CT to enhance cardiovascular risk stratification.</jats:p> <jats:p><jats:italic>Trial registration</jats:italic> NCT00927693.</jats:p> </jats:sec>
  • Access State: Open Access