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PurposeTo assess the association between non-alcoholic fatty liver disease (NAFLD) and quantitative atherosclerotic plaque on CT. Materials and MethodsIn this post-hoc analysis of the prospective Scottish Computed Tomography of the HEART trial (November 2010 to September 2014), hepatosteatosis and coronary artery calcium score were measured on non-contrast CT. Presence of stenoses, visually assessed high-risk plaque, and quantitative plaque burden were assessed on coronary CT angiography. Multivariable models were constructed to assess the impact of hepatosteatosis and cardiovascular risk factors on coronary artery disease.ResultsImages from 1726 participants (mean age, 58 years  9 [standard deviation]; 974 men) were included. Participants with hepatosteatosis (n=155/1726, 9%) had a higher BMI, more hypertension and diabetes mellitus, and higher cardiovascular risk scores (P < .001 for all) compared with those without hepatosteatosis. They had increased coronary artery calcium scores (median, 43 [interquartile range, 0 to 273] Agatston units [AU] versus 19 [0 to 225] AU, P = .046), more non-obstructive disease (48% versus 37%, P = .02) and higher low-attenuation plaque burden (5.11% [0 to 7.16] versus 4.07% [0 to 6.84], P = .04). However, these associations were not independent of cardiovascular risk factors. Over median 4.7 years, there was no evidence of a difference in myocardial infarction between those with and without hepatosteatosis (1.9% versus 2.4%, P = .92). Conclusion Hepatosteatosis on CT was associated with an increased prevalence of coronary artery disease on CT, but this was not independent of the presence of cardiovascular risk factors.

Objectives: Ultra-small superparamagnetic particles of iron oxide (USPIO)-enhanced MRI can detect cellular inflammation within tissues and may help non-invasively identify cardiac transplant rejection. Here, we aimed to determine the normal reference values for USPIO-enhanced MRI in patients with a prior cardiac transplant and examine whether USPIO-enhanced MRI could detect myocardial inflammation in patients with transplant rejection.Methods: Ten volunteers and 11 patients with cardiac transplant underwent T2, T2* and late gadolinium enhancement 1.5T MRI, with further T2* imaging at 24 hours after USPIO (ferumoxytol, 4 mg/kg) infusion, at baseline and 3 months.Results: Ten patients with clinically stable cardiac transplantation were retained for analysis. Myocardial T2 values were higher in patients with cardiac transplant versus healthy volunteers (53.8±5.2 vs 48.6±1.9 ms, respectively; p=0.003). There were no differences in the magnitude of USPIO-induced change in R2* in patients with transplantation (change in R2*, 26.6±7.3 vs 22.0±10.4 s-1 in healthy volunteers; p=0.28). After 3 months, patients with transplantation (n=5) had unaltered T2 values (52.7±2.8 vs 52.12±3.4 ms; p=0.80) and changes in R2* following USPIO (29.42±8.14 vs 25.8±7.8 s-1; p=0.43).Conclusion: Stable patients with cardiac transplantation have increased myocardial T2 values, consistent with resting myocardial oedema or fibrosis. In contrast, USPIO-enhanced MRI is normal and stable over time suggesting the absence of chronic macrophage-driven cellular inflammation. It remains to be determined whether USPIO-enhanced MRI may be able to identify acute cardiac transplant rejection.Trial registration number: NCT02319278349 (https://clinicaltrials.gov/ct2/show/NCT02319278) Registered 03.12.2014 EUDraCT 2013-002336-24.

Background: Unlike most noninvasive imaging modalities, coronary computed tomography angiography can characterize subtypes of atherosclerotic plaque.Objectives: The purpose of this study was to investigate the prognostic implications of adverse coronary plaque characteristics in patients with suspected coronary artery disease.Methods: In this SCOT-HEART (Scottish COmputed Tomography of the HEART Trial) post hoc analysis, the presence of adverse plaque (positive remodeling or low attenuation plaque), obstructive disease, and coronary artery calcification within 15 coronary segments was assessed on coronary computed tomography angiography of 1,769 patients who were followed-up for 5 years.Results: Among study participants (mean age 58 ± 10 years; 56% male), 608 (34%) patients had 1 or more adverse plaque features. Coronary heart disease death or nonfatal myocardial infarction was 3 times more frequent in patients with adverse plaque (n = 25 of 608 [4.1%] vs. n = 16 of 1,161 [1.4%]; p < 0.001; hazard ratio [HR]: 3.01; 95% confidence interval (CI): 1.61 to 5.63; p = 0.001) and was twice as frequent in those with obstructive disease (n = 22 of 452 [4.9%] vs. n = 16 of 671 [2.4%]; p = 0.024; HR: 1.99; 95% CI: 1.05 to 3.79; p = 0.036). Patients with both obstructive disease and adverse plaque had the highest event rate, with a 10-fold increase in coronary heart disease death or nonfatal myocardial infarction compared with patients with normal coronary arteries (HR: 11.50; 95% CI: 3.39 to 39.04; p < 0.001). However, these associations were not independent of coronary artery calcium score, a surrogate measure of coronary plaque burden.Conclusions: Adverse coronary plaque characteristics and overall calcified plaque burden confer an increased risk of coronary heart disease death or nonfatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590)

Background -With advances in anti-retroviral therapy, most deaths in people with human immune-deficiency virus (HIV) are now due to non-communicable illnesses especially cardiovascular disease. We determine the association between HIV and cardiovascular disease, and estimate the national, regional and global burden of cardiovascular disease attributable to HIV. Methods -We conducted a systematic review across five databases from inception to August 2016 for longitudinal studies of cardiovascular disease in HIV infection. A random-effects meta-analysis across eighty studies was used to derive the pooled rate and risk of cardiovascular disease in people living with HIV. We then estimated the temporal changes in the population attributable fraction and disability-adjusted life years (DALYs) from HIV associated cardiovascular disease from 1990 to 2015 at a regional and global level. National cardiovascular DALYs associated with HIV for 2015 were derived for 154 of the 193 United Nations member states. The main outcome measure was the pooled estimate of the rate and risk of cardiovascular disease in people living with HIV and the national, regional and global estimates of DALYs from cardiovascular disease associated with HIV. Results -In 793,635 people living with HIV and a total follow-up of 3.5 million person-years, the crude rate of cardiovascular disease was 61.8 (95% confidence interval [CI] 45.8-83.4) per 10,000 person-years. Compared to individuals without HIV, the risk ratio for cardiovascular disease was 2.16 (95%CI 1.68-2.77). Over the last 26 years, the global population attributable fraction from cardiovascular disease due to HIV increased from 0.36% (95%CI 0.21-0.56%) to 0.92% (95%CI 0.55-1.41%) and DALYs increased from 0.74 (95%CI 0.44-1.16) to 2.57 (95%CI 1.53-3.92) million. There was marked regional variation with most DALYs lost in sub-Saharan Africa (0.87 million, 95%CI 0.43-1.70) and the Asia-Pacific (0.39 million, 95%CI 0.23-0.62) regions. The highest population attributable fraction and burden was observed in Swaziland, Botswana and Lesotho. Conclusions -People living with HIV are twice as likely to develop cardiovascular disease. The global burden of HIV associated cardiovascular disease has tripled over the last two decades and is now responsible for 2.6 million DALYs per annum with the greatest impact in sub-Saharan Africa and the Asia-Pacific regions. PROSPERO Registration -URL: https://www.crd.york.ac.uk/prospero Unique Identifier: CRD42016048257.