Skip to main content
Top
Published in: Journal of Gastroenterology 3/2019

01-03-2019 | Original Article—Liver, Pancreas, and Biliary Tract

Clinical significance of hepatic steatosis according to coronary plaque morphology: assessment using controlled attenuation parameter

Authors: Hyo Eun Park, Heesun Lee, Su-Yeon Choi, Min-Sun Kwak, Jong In Yang, Jeong Yoon Yim, Goh Eun Chung

Published in: Journal of Gastroenterology | Issue 3/2019

Login to get access

Abstract

Background

Nonalcoholic fatty liver disease (NAFLD) plays a significant role in coronary atherosclerosis, independent of shared metabolic risk factors. The measurement of the controlled attenuation parameter (CAP) has shown to allow early and noninvasive detection of NAFLD at subclinical stage. We evaluated the significance of CAP-defined NAFLD in association with the presence of any type of coronary plaques and different plaque compositions.

Methods

We conducted a retrospective cohort of apparently healthy subjects who had liver Fibroscan and coronary computed tomography during health screening exams.

Results

A greater number of subjects with CAP-defined NAFLD was found in group with coronary plaques (61.3% vs. 73.5%, p = 0.005 without vs. with any type of plaque). From multivariate regression model, CAP ≥ 222 dB/m was an independent and significant parameter associated with the presence of coronary plaques, after adjusting possible confounders (OR 1.624, 95% 1.047–2.518, p = 0.030). Interestingly, CAP ≥ 222 dB/m was significantly associated with non-calcified plaque (adjusted OR 3.528, 95% CI 1.463–8.511, p = 0.005), whereas it was not significant in calcified plaques (p = 0.171).

Conclusion

CAP-defined NAFLD is independently associated with coronary plaques, especially non-calcified plaques. The association between NAFLD and non-calcified plaques suggests that particular attention should be given to the subjects with NAFLD for primary prevention.
Appendix
Available only for authorised users
Literature
1.
go back to reference Targher G, Marra F, Marchesini G. Increased risk of cardiovascular disease in non-alcoholic fatty liver disease: causal effect or epiphenomenon? Diabetologia. 2008;51:1947–53.CrossRefPubMed Targher G, Marra F, Marchesini G. Increased risk of cardiovascular disease in non-alcoholic fatty liver disease: causal effect or epiphenomenon? Diabetologia. 2008;51:1947–53.CrossRefPubMed
2.
go back to reference Park HE, Kwak MS, Kim D, et al. Nonalcoholic fatty liver disease is associated with coronary artery calcification development: a longitudinal study. J Clin Endocrinol Metab. 2016;101:3134–43.CrossRefPubMed Park HE, Kwak MS, Kim D, et al. Nonalcoholic fatty liver disease is associated with coronary artery calcification development: a longitudinal study. J Clin Endocrinol Metab. 2016;101:3134–43.CrossRefPubMed
3.
go back to reference Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther. 2011;34:274–85.CrossRefPubMed Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther. 2011;34:274–85.CrossRefPubMed
4.
go back to reference Chung GE, Choi SY, Kim D, et al. Nonalcoholic fatty liver disease as a risk factor of arterial stiffness measured by the cardioankle vascular index. Medicine (Baltimore). 2015;94:e654.CrossRef Chung GE, Choi SY, Kim D, et al. Nonalcoholic fatty liver disease as a risk factor of arterial stiffness measured by the cardioankle vascular index. Medicine (Baltimore). 2015;94:e654.CrossRef
5.
go back to reference Choi SY, Kim D, Kim HJ, et al. The relation between non-alcoholic fatty liver disease and the risk of coronary heart disease in Koreans. Am J Gastroenterol. 2009;104:1953–60.CrossRefPubMed Choi SY, Kim D, Kim HJ, et al. The relation between non-alcoholic fatty liver disease and the risk of coronary heart disease in Koreans. Am J Gastroenterol. 2009;104:1953–60.CrossRefPubMed
6.
go back to reference Karlas T, Petroff D, Sasso M, et al. Individual patient data meta-analysis of controlled attenuation parameter (CAP) technology for assessing steatosis. J Hepatol. 2017;66:1022–30.CrossRefPubMed Karlas T, Petroff D, Sasso M, et al. Individual patient data meta-analysis of controlled attenuation parameter (CAP) technology for assessing steatosis. J Hepatol. 2017;66:1022–30.CrossRefPubMed
7.
go back to reference Sasso M, Beaugrand M, de Ledinghen V, et al. Controlled attenuation parameter (CAP): a novel VCTE guided ultrasonic attenuation measurement for the evaluation of hepatic steatosis: preliminary study and validation in a cohort of patients with chronic liver disease from various causes. Ultrasound Med Biol. 2010;36:1825–35.CrossRefPubMed Sasso M, Beaugrand M, de Ledinghen V, et al. Controlled attenuation parameter (CAP): a novel VCTE guided ultrasonic attenuation measurement for the evaluation of hepatic steatosis: preliminary study and validation in a cohort of patients with chronic liver disease from various causes. Ultrasound Med Biol. 2010;36:1825–35.CrossRefPubMed
8.
go back to reference Recio E, Cifuentes C, Macias J, et al. Interobserver concordance in controlled attenuation parameter measurement, a novel tool for the assessment of hepatic steatosis on the basis of transient elastography. Eur J Gastroenterol Hepatol. 2013;25:905–11.CrossRefPubMed Recio E, Cifuentes C, Macias J, et al. Interobserver concordance in controlled attenuation parameter measurement, a novel tool for the assessment of hepatic steatosis on the basis of transient elastography. Eur J Gastroenterol Hepatol. 2013;25:905–11.CrossRefPubMed
9.
go back to reference Myers RP, Pollett A, Kirsch R, et al. Controlled Attenuation Parameter (CAP): a noninvasive method for the detection of hepatic steatosis based on transient elastography. Liver Int. 2012;32:902–10.CrossRefPubMed Myers RP, Pollett A, Kirsch R, et al. Controlled Attenuation Parameter (CAP): a noninvasive method for the detection of hepatic steatosis based on transient elastography. Liver Int. 2012;32:902–10.CrossRefPubMed
10.
go back to reference de Ledinghen V, Vergniol J, Foucher J, et al. Non-invasive diagnosis of liver steatosis using controlled attenuation parameter (CAP) and transient elastography. Liver Int. 2012;32:911–8.CrossRefPubMed de Ledinghen V, Vergniol J, Foucher J, et al. Non-invasive diagnosis of liver steatosis using controlled attenuation parameter (CAP) and transient elastography. Liver Int. 2012;32:911–8.CrossRefPubMed
11.
go back to reference You SC, Kim KJ, Kim SU, et al. Hepatic fibrosis assessed using transient elastography independently associated with coronary artery calcification. J Gastroenterol Hepatol. 2015;30:1536–42.CrossRefPubMed You SC, Kim KJ, Kim SU, et al. Hepatic fibrosis assessed using transient elastography independently associated with coronary artery calcification. J Gastroenterol Hepatol. 2015;30:1536–42.CrossRefPubMed
12.
go back to reference Naghavi M, Libby P, Falk E, et al. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: part II. Circulation. 2003;108:1772–8.CrossRefPubMed Naghavi M, Libby P, Falk E, et al. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: part II. Circulation. 2003;108:1772–8.CrossRefPubMed
13.
go back to reference van Velzen JE, de Graaf FR, Jukema JW, et al. Comparison of the relation between the calcium score and plaque characteristics in patients with acute coronary syndrome versus patients with stable coronary artery disease, assessed by computed tomography angiography and virtual histology intravascular ultrasound. Am J Cardiol. 2011;108:658–64.CrossRefPubMed van Velzen JE, de Graaf FR, Jukema JW, et al. Comparison of the relation between the calcium score and plaque characteristics in patients with acute coronary syndrome versus patients with stable coronary artery disease, assessed by computed tomography angiography and virtual histology intravascular ultrasound. Am J Cardiol. 2011;108:658–64.CrossRefPubMed
14.
go back to reference Hausleiter J, Meyer T, Hadamitzky M, et al. Prevalence of noncalcified coronary plaques by 64-slice computed tomography in patients with an intermediate risk for significant coronary artery disease. J Am Coll Cardiol. 2006;48:312–8.CrossRefPubMed Hausleiter J, Meyer T, Hadamitzky M, et al. Prevalence of noncalcified coronary plaques by 64-slice computed tomography in patients with an intermediate risk for significant coronary artery disease. J Am Coll Cardiol. 2006;48:312–8.CrossRefPubMed
15.
go back to reference Kang MK, Kang BH, Kim JH. Nonalcoholic fatty liver disease is associated with the presence and morphology of subclinical coronary atherosclerosis. Yonsei Med J. 2015;56:1288–95.CrossRefPubMedPubMedCentral Kang MK, Kang BH, Kim JH. Nonalcoholic fatty liver disease is associated with the presence and morphology of subclinical coronary atherosclerosis. Yonsei Med J. 2015;56:1288–95.CrossRefPubMedPubMedCentral
16.
go back to reference Osawa K, Miyoshi T, Yamauchi K, et al. Nonalcoholic hepatic steatosis is a strong predictor of high-risk coronary-artery plaques as determined by multidetector CT. PLoS One. 2015;10:e0131138.CrossRefPubMedPubMedCentral Osawa K, Miyoshi T, Yamauchi K, et al. Nonalcoholic hepatic steatosis is a strong predictor of high-risk coronary-artery plaques as determined by multidetector CT. PLoS One. 2015;10:e0131138.CrossRefPubMedPubMedCentral
17.
go back to reference Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology. 2012;142:1592–609.CrossRefPubMed Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology. 2012;142:1592–609.CrossRefPubMed
18.
go back to reference Chung GE, Kim D, Kwak MS, et al. The serum vitamin D level is inversely correlated with nonalcoholic fatty liver disease. Clin Mol Hepatol. 2016;22:146–51.CrossRefPubMedPubMedCentral Chung GE, Kim D, Kwak MS, et al. The serum vitamin D level is inversely correlated with nonalcoholic fatty liver disease. Clin Mol Hepatol. 2016;22:146–51.CrossRefPubMedPubMedCentral
19.
go back to reference Choi SY, Kim D, Oh BH, et al. General and abdominal obesity and abdominal visceral fat accumulation associated with coronary artery calcification in Korean men. Atherosclerosis. 2010;213:273–8.CrossRefPubMed Choi SY, Kim D, Oh BH, et al. General and abdominal obesity and abdominal visceral fat accumulation associated with coronary artery calcification in Korean men. Atherosclerosis. 2010;213:273–8.CrossRefPubMed
20.
go back to reference Sandrin L, Fourquet B, Hasquenoph JM, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003;29:1705–13.CrossRefPubMed Sandrin L, Fourquet B, Hasquenoph JM, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003;29:1705–13.CrossRefPubMed
21.
go back to reference Boursier J, Zarski JP, de Ledinghen V, et al. Determination of reliability criteria for liver stiffness evaluation by transient elastography. Hepatology. 2013;57:1182–91.CrossRefPubMed Boursier J, Zarski JP, de Ledinghen V, et al. Determination of reliability criteria for liver stiffness evaluation by transient elastography. Hepatology. 2013;57:1182–91.CrossRefPubMed
22.
go back to reference Kwok R, Choi KC, Wong GL, et al. Screening diabetic patients for non-alcoholic fatty liver disease with controlled attenuation parameter and liver stiffness measurements: a prospective cohort study. Gut. 2016;65:1359–68.CrossRefPubMed Kwok R, Choi KC, Wong GL, et al. Screening diabetic patients for non-alcoholic fatty liver disease with controlled attenuation parameter and liver stiffness measurements: a prospective cohort study. Gut. 2016;65:1359–68.CrossRefPubMed
23.
go back to reference Kwak MS, Chung GE, Yang JI, et al. Clinical implications of controlled attenuation parameter in a health check-up cohort. Liver Int. 2017;38:915–23.CrossRefPubMed Kwak MS, Chung GE, Yang JI, et al. Clinical implications of controlled attenuation parameter in a health check-up cohort. Liver Int. 2017;38:915–23.CrossRefPubMed
24.
go back to reference Achenbach S, Moselewski F, Ropers D, et al. Detection of calcified and noncalcified coronary atherosclerotic plaque by contrast-enhanced, submillimeter multidetector spiral computed tomography: a segment-based comparison with intravascular ultrasound. Circulation. 2004;109:14–7.CrossRefPubMed Achenbach S, Moselewski F, Ropers D, et al. Detection of calcified and noncalcified coronary atherosclerotic plaque by contrast-enhanced, submillimeter multidetector spiral computed tomography: a segment-based comparison with intravascular ultrasound. Circulation. 2004;109:14–7.CrossRefPubMed
25.
go back to reference Angulo P, Keach JC, Batts KP, et al. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology. 1999;30:1356–62.CrossRefPubMed Angulo P, Keach JC, Batts KP, et al. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology. 1999;30:1356–62.CrossRefPubMed
26.
go back to reference Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38:518–26.CrossRefPubMed Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38:518–26.CrossRefPubMed
27.
go back to reference Vallet-Pichard A, Mallet V, Nalpas B, et al. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. Comparison with liver biopsy and fibrotest. Hepatology. 2007;46:32–6.CrossRefPubMed Vallet-Pichard A, Mallet V, Nalpas B, et al. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. Comparison with liver biopsy and fibrotest. Hepatology. 2007;46:32–6.CrossRefPubMed
28.
go back to reference McPherson S, Stewart SF, Henderson E, et al. Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease. Gut. 2010;59:1265–9.CrossRefPubMed McPherson S, Stewart SF, Henderson E, et al. Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease. Gut. 2010;59:1265–9.CrossRefPubMed
29.
go back to reference Kim JK, Lee KS, Choi JR, et al. Usefulness of the controlled attenuation parameter for detecting liver steatosis in health checkup examinees. Gut Liver. 2015;9:405–10.PubMedPubMedCentral Kim JK, Lee KS, Choi JR, et al. Usefulness of the controlled attenuation parameter for detecting liver steatosis in health checkup examinees. Gut Liver. 2015;9:405–10.PubMedPubMedCentral
30.
go back to reference Ferraioli G, Tinelli C, Lissandrin R, et al. Correlation of the controlled attenuation parameter with indices of liver steatosis in overweight or obese individuals: a pilot study. Eur J Gastroenterol Hepatol. 2015;27:305–12.CrossRefPubMed Ferraioli G, Tinelli C, Lissandrin R, et al. Correlation of the controlled attenuation parameter with indices of liver steatosis in overweight or obese individuals: a pilot study. Eur J Gastroenterol Hepatol. 2015;27:305–12.CrossRefPubMed
31.
go back to reference Wong VW, Wong GL, Yip GW, et al. Coronary artery disease and cardiovascular outcomes in patients with non-alcoholic fatty liver disease. Gut. 2011;60:1721–7.CrossRefPubMed Wong VW, Wong GL, Yip GW, et al. Coronary artery disease and cardiovascular outcomes in patients with non-alcoholic fatty liver disease. Gut. 2011;60:1721–7.CrossRefPubMed
32.
go back to reference Targher G, Day CP, Bonora E. Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease. N Engl J Med. 2010;363:1341–50.CrossRefPubMed Targher G, Day CP, Bonora E. Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease. N Engl J Med. 2010;363:1341–50.CrossRefPubMed
33.
go back to reference Kotronen A, Yki-Jarvinen H. Fatty liver: a novel component of the metabolic syndrome. Arterioscler Thromb Vasc Biol. 2008;28:27–38.CrossRefPubMed Kotronen A, Yki-Jarvinen H. Fatty liver: a novel component of the metabolic syndrome. Arterioscler Thromb Vasc Biol. 2008;28:27–38.CrossRefPubMed
34.
go back to reference Mellinger JL, Pencina KM, Massaro JM, et al. Hepatic steatosis and cardiovascular disease outcomes: an analysis of the Framingham Heart Study. J Hepatol. 2015;63:470–6.CrossRefPubMedPubMedCentral Mellinger JL, Pencina KM, Massaro JM, et al. Hepatic steatosis and cardiovascular disease outcomes: an analysis of the Framingham Heart Study. J Hepatol. 2015;63:470–6.CrossRefPubMedPubMedCentral
35.
go back to reference Akabame S, Hamaguchi M, Tomiyasu K, et al. Evaluation of vulnerable coronary plaques and non-alcoholic fatty liver disease (NAFLD) by 64-detector multislice computed tomography (MSCT). Circ J. 2008;72:618–25.CrossRefPubMed Akabame S, Hamaguchi M, Tomiyasu K, et al. Evaluation of vulnerable coronary plaques and non-alcoholic fatty liver disease (NAFLD) by 64-detector multislice computed tomography (MSCT). Circ J. 2008;72:618–25.CrossRefPubMed
36.
go back to reference Assy N, Djibre A, Farah R, et al. Presence of coronary plaques in patients with nonalcoholic fatty liver disease. Radiology. 2010;254:393–400.CrossRefPubMed Assy N, Djibre A, Farah R, et al. Presence of coronary plaques in patients with nonalcoholic fatty liver disease. Radiology. 2010;254:393–400.CrossRefPubMed
37.
go back to reference Puchner SB, Lu MT, Mayrhofer T, et al. High-risk coronary plaque at coronary CT angiography is associated with nonalcoholic fatty liver disease, independent of coronary plaque and stenosis burden: results from the ROMICAT II trial. Radiology. 2015;274:693–701.CrossRefPubMed Puchner SB, Lu MT, Mayrhofer T, et al. High-risk coronary plaque at coronary CT angiography is associated with nonalcoholic fatty liver disease, independent of coronary plaque and stenosis burden: results from the ROMICAT II trial. Radiology. 2015;274:693–701.CrossRefPubMed
38.
go back to reference Papatheodoridis GV, Chrysanthos N, Cholongitas E, et al. Thrombotic risk factors and liver histologic lesions in non-alcoholic fatty liver disease. J Hepatol. 2009;51:931–8.CrossRefPubMed Papatheodoridis GV, Chrysanthos N, Cholongitas E, et al. Thrombotic risk factors and liver histologic lesions in non-alcoholic fatty liver disease. J Hepatol. 2009;51:931–8.CrossRefPubMed
39.
go back to reference Targher G, Byrne CD. Diagnosis and management of nonalcoholic fatty liver disease and its hemostatic/thrombotic and vascular complications. Semin Thromb Hemost. 2013;39:214–28.CrossRefPubMed Targher G, Byrne CD. Diagnosis and management of nonalcoholic fatty liver disease and its hemostatic/thrombotic and vascular complications. Semin Thromb Hemost. 2013;39:214–28.CrossRefPubMed
40.
go back to reference Targher G, Bertolini L, Scala L, et al. Non-alcoholic hepatic steatosis and its relation to increased plasma biomarkers of inflammation and endothelial dysfunction in non-diabetic men. Role of visceral adipose tissue. Diabet Med. 2005;22:1354–8.CrossRefPubMed Targher G, Bertolini L, Scala L, et al. Non-alcoholic hepatic steatosis and its relation to increased plasma biomarkers of inflammation and endothelial dysfunction in non-diabetic men. Role of visceral adipose tissue. Diabet Med. 2005;22:1354–8.CrossRefPubMed
41.
go back to reference Targher G. Relationship between high-sensitivity C-reactive protein levels and liver histology in subjects with non-alcoholic fatty liver disease. J Hepatol. 2006;45:879–81 (author reply 881–872).CrossRefPubMed Targher G. Relationship between high-sensitivity C-reactive protein levels and liver histology in subjects with non-alcoholic fatty liver disease. J Hepatol. 2006;45:879–81 (author reply 881–872).CrossRefPubMed
42.
go back to reference Yener S, Akarsu M, Demir T, et al. Plasminogen activator inhibitor-1 and thrombin activatable fibrinolysis inhibitor levels in non-alcoholic steatohepatitis. J Endocrinol Investig. 2007;30:810–9.CrossRef Yener S, Akarsu M, Demir T, et al. Plasminogen activator inhibitor-1 and thrombin activatable fibrinolysis inhibitor levels in non-alcoholic steatohepatitis. J Endocrinol Investig. 2007;30:810–9.CrossRef
43.
go back to reference Danesh J, Wheeler JG, Hirschfield GM, et al. C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med. 2004;350:1387–97.CrossRefPubMed Danesh J, Wheeler JG, Hirschfield GM, et al. C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med. 2004;350:1387–97.CrossRefPubMed
44.
go back to reference Ridker PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation. 2003;107:363–9.CrossRefPubMed Ridker PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation. 2003;107:363–9.CrossRefPubMed
45.
go back to reference Burke AP, Tracy RP, Kolodgie F, et al. Elevated C-reactive protein values and atherosclerosis in sudden coronary death: association with different pathologies. Circulation. 2002;105:2019–23.CrossRefPubMed Burke AP, Tracy RP, Kolodgie F, et al. Elevated C-reactive protein values and atherosclerosis in sudden coronary death: association with different pathologies. Circulation. 2002;105:2019–23.CrossRefPubMed
46.
go back to reference Norja S, Nuutila L, Karhunen PJ, et al. C-reactive protein in vulnerable coronary plaques. J Clin Pathol. 2007;60:545–8.CrossRefPubMed Norja S, Nuutila L, Karhunen PJ, et al. C-reactive protein in vulnerable coronary plaques. J Clin Pathol. 2007;60:545–8.CrossRefPubMed
47.
go back to reference Kubo T, Matsuo Y, Hayashi Y, et al. High-sensitivity C-reactive protein and plaque composition in patients with stable angina pectoris: a virtual histology intravascular ultrasound study. Coron Artery Dis. 2009;20:531–5.CrossRefPubMed Kubo T, Matsuo Y, Hayashi Y, et al. High-sensitivity C-reactive protein and plaque composition in patients with stable angina pectoris: a virtual histology intravascular ultrasound study. Coron Artery Dis. 2009;20:531–5.CrossRefPubMed
48.
go back to reference Caussy C, Alquiraish MH, Nguyen P, et al. Optimal threshold of controlled attenuation parameter with MRI-PDFF as the gold standard for the detection of hepatic steatosis. Hepatology. 2018;67:1348–59.CrossRefPubMedPubMedCentral Caussy C, Alquiraish MH, Nguyen P, et al. Optimal threshold of controlled attenuation parameter with MRI-PDFF as the gold standard for the detection of hepatic steatosis. Hepatology. 2018;67:1348–59.CrossRefPubMedPubMedCentral
Metadata
Title
Clinical significance of hepatic steatosis according to coronary plaque morphology: assessment using controlled attenuation parameter
Authors
Hyo Eun Park
Heesun Lee
Su-Yeon Choi
Min-Sun Kwak
Jong In Yang
Jeong Yoon Yim
Goh Eun Chung
Publication date
01-03-2019
Publisher
Springer Japan
Published in
Journal of Gastroenterology / Issue 3/2019
Print ISSN: 0944-1174
Electronic ISSN: 1435-5922
DOI
https://doi.org/10.1007/s00535-018-1516-5

Other articles of this Issue 3/2019

Journal of Gastroenterology 3/2019 Go to the issue

Acknowledgment

Acknowledgements