Non-invasive assessment of steatohepatitis indicates increased risk of coronary artery disease

Sebastian Beer; Jonas Babel; Neef Martin; Valentin Blank; Johannes Wiegand; Thomas Karlas

doi:10.1371/journal.pone.0286882

Non-invasive assessment of steatohepatitis indicates increased risk of coronary artery disease

PLoS One. 2023 Sep 28;18(9):e0286882. doi: 10.1371/journal.pone.0286882. eCollection 2023.

Authors

Sebastian Beer^{1

2}, Jonas Babel^{1

3}, Neef Martin⁴, Valentin Blank^{1

5}, Johannes Wiegand⁶, Thomas Karlas¹

Affiliations

¹ Department of Medicine II, Division of Gastroenterology, Leipzig University Medical Center, Leipzig, Germany.
² Integrated Research and Treatment Center Adiposity Diseases, Faculty of Medicine, University of Leipzig, Leipzig, Germany.
³ Department of Operative Medicine II, Division of Visceral-, Transplant-, Thoracic- and Vascular Surgery, Leipzig University Medical Center, Leipzig, Germany.
⁴ Department of Cardiology, Leipzig University Medical Center, Leipzig, Germany.
⁵ Department of Internal Medicine I (Gastroenterology, Pneumology) and Division of Interdisciplinary Ultrasound, University Hospital Halle (Saale), Halle (Saale), Germany.
⁶ Department of Medicine II, Division of Hepatology, Leipzig University Medical Center, Leipzig, Germany.

Abstract

Introduction: Fatty liver diseases (FLD), especially defined as metabolic dysfunction-associated FLD (MAFLD), is of growing importance for patients and health-care providers. Extrahepatic comorbidities, predominantly coronary artery disease (CAD), contribute to excess morbidity and mortality in FLD. Although the association of FLD and CAD is well known, underlying pathophysiological links are not fully understood. Non-invasive means of liver diagnostic enable a fast and thorough characterization of FLD. We therefore assessed the severity of FLD in a cohort of patients at risk of CAD.

Methods: Patients scheduled for coronary angiography were characterized by anthropometry, serum-based indices of liver fibrosis (NFS, FIB4), abdominal ultrasound and vibration controlled transient elastography (VCTE) including controlled attenuation parameter (CAP) and the Fibroscan-AST (FAST) score. Patients were stratified according to indication of therapeutic coronary intervention.

Results: 120 patients were recruited, MAFLD was found in 41%, while advanced fibrosis or cirrhosis were present in only 5%. Coronary vascular intervention was indicated in 42% (n = 50). Severity of steatosis assessed by CAP and risk of fibrosis defined by elevated liver stiffness (VCTE>8 kPa) and fibrosis indices were associated with the need for coronary intervention. FAST score, a marker of fibrotic steatohepatitis, was elevated in the intervention group (0.22 vs. 0.12, p<0.001). Multivariate regression analysis revealed FAST score as strongest predictor of CAD (OR 2.3 95%, CI 1.40-2.96).

Discussion: MAFLD is a frequent comorbidity in patients at CAD risk, but advanced liver disease has a low prevalence in patients undergoing elective coronary angiography. Therefore, a routine VCTE-based screening for FLD cannot be recommended in cardiac patients. The association of indicators of steatohepatitis with advanced CAD points to inflammatory processes as a conjoint mechanism of both diseases.

Copyright: © 2023 Beer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Coronary Artery Disease* / complications
Coronary Artery Disease* / diagnostic imaging
Elasticity Imaging Techniques*
Fibrosis
Humans
Liver Cirrhosis / complications
Liver Cirrhosis / diagnosis
Non-alcoholic Fatty Liver Disease* / complications
Non-alcoholic Fatty Liver Disease* / diagnosis
Non-alcoholic Fatty Liver Disease* / epidemiology
Prevalence

Grants and funding

This work was supported by the Federal Ministry of Education and Research (BMBF) by a MetaRot Grant of the Integrated Research and Treatment Center AdiposityDiseases Leipzig (IFB), Germany, FKZ01EO1001 to SB. https://www.ifb-adipositas.de/en The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.