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Hepatic steatosis has been associated with increased risk of coronary artery disease. Individuals with familial hypercholesterolaemia have accelerated but variable progression of coronary artery disease. We investigated whether hepatic steatosis is associated with novel coronary atherosclerosis biomarkers in adults with heterozygous familial hypercholesterolaemia, using comprehensive coronary computed tomographic angiography. We conducted a cross-sectional study of 213 asymptomatic patients with familial hypercholesterolaemia (median age 54.0 years, 59 % female) who underwent coronary computed tomographic angiography for cardiovascular risk assessment in an outpatient clinic. High-risk plaque features, plaque volume and pericoronary adipose tissue attenuation were assessed. From concurrently captured upper abdominal images, severity of hepatic steatosis was computed, as liver minus spleen computed tomography attenuation and stratified into quartiles. Of 213 familial hypercholesterolaemia patients, 59 % had coronary artery calcium, 36 % obstructive coronary artery disease (≥50 % stenosis) and 77 % high-risk plaque features. Increasing hepatic steatosis was associated with higher calcium scores, more high-risk plaque features and presence of obstructive coronary artery disease. Hepatic steatosis was associated with the presence of high-risk plaque features (OR: 1.48; 95 % CI: 1.09–2.00; p = 0.01), particularly in the proximal coronary segments (OR: 1.52; 95 % CI: 1.18–1.96; p = 0.001). Associations persisted on multivariable logistic regression analysis adjusting for cardiometabolic factors, obstructive coronary artery disease and calcium score. Hepatic steatosis was associated with higher plaque volumes (Q4: 499 mm3 vs Q1: 414 mm3, p = 0.02), involving mainly low attenuation and noncalcified plaques (both p = 0.03). No differences in pericoronary adipose tissue attenuation were observed. Hepatic steatosis is associated with multiple indices of advanced coronary atherosclerosis in familial hypercholesterolaemia patients, particularly high-risk plaque features, independent of conventional cardiovascular risk factors and markers. This may involve specific mechanisms related to hepatic steatosis. Clinical trial number: N/A. [Display omitted] • Hepatic fat independently predicts high-risk coronary artery plaque features in FH. • Hepatic fat associates with higher low attenuation and non-calcified plaque volumes. • CT assessment of hepatic fat may add incremental value to CVD risk stratification. [ABSTRACT FROM AUTHOR]

To retrospectively compare the diagnostic accuracy of attenuation imaging (ATI) to detect and grade hepatic steatosis as determined by liver biopsy in a cohort of adult patients with a variety of suspected liver pathologies referred for liver sonography and biopsy. 76 patients met the criteria of having a liver biopsy performed within 4 weeks of an ATI assessment with exclusion of malignancy and prior liver resection. Patients had a median age of 50.5 (range 18-83) years (51 women, 25 men) with median BMI of 28.9 kg/m2 (range 19.2-57.2, IQR 24-33.3). ATI, shear wave elastography (SWE), shear wave dispersion (SWD) and skin to liver capsule distance (SCD) measurements were obtained. Metavir fibrosis and Brunt steatosis grading as well as the presence/absence of inflammation were noted. Controlled attenuation parameter (CAP) values were also recorded, where available. The results were analysed using Spearman correlation coefficient, receiver operator characteristic and multiple logistic model performances to assess correlations, diagnostic performance and discriminate between steatosis grades according to ATI measurement. The distribution of steatosis according to histology was 33/13/23/7 for S0 (<5%), S1(5-33%), S2(33-66%) and S3(>66%). The median ATI value for each biopsy steatosis grade was 0.60 (IQR 0.52-0.65), 0.65 (IQR 0.6-0.71), 0.83 (IQR 0.74-0.90) and 0.90 (IQR 0.82-1.01) dB/cm/MHz for S0, S1, S2 and S3. The AUC of ATI for detection of any steatosis grade (S1-S3) and moderate to severe steatosis (S2-S3) was 0.85 (95% CI, 0.748-0.908) and 0.91 (95% CI, 0.830-0.986) with cutoffs of 0.55 and 0.62 dB/cm/MHz. Logistic regression boundary value of 0.74dB/cm/MHz was able to discriminate between S0-S1 and S2-3 with accuracy, CI and kappa statistic of 0.8889, 0.6529-0.0862 and 0.7534. ATI correlations were SCD (ρ=0.40), BMI (ρ=0.39), CAP (ρ=0.49), SWD (ρ=-0.21) and SWE (ρ=-0.04). There was good correlation between ATI and histological steatosis grade, which was the only significant factor affecting the ATI measurement. The most accurate discrimination was between none to mild (S0-1) and moderate to severe (S2-3) steatosis. [ABSTRACT FROM AUTHOR]