The Prevalence of Hepatic Steatosis in Patients With Normal Coronary Computed Tomography Angiography: Is It Time for a Paradigm Shift?

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.