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Published on: August 25, 2023
Subclinical hepatic fibrosis is associated with coronary microvascular dysfunction by myocardial perfusion reserve
Alan C Kwan1, Janet Wei2, Brian P Lee3
1Division of Digestive and Liver Diseases, and Department of Imaging, Barbra Streisand Women's Heart Center, Biomedical Imaging Research Institute, Smidt Heart Institute Department of Cardiology, Cedars Sinai Medical Center, 127 S San Vicente Blvd #A3600, Los Angeles, CA, 90048, USA. alan.kwan@cshs.org.
Insights
Hepatic fibrosis, measured by the Fibrosis-4 (Fib-4) score, is linked to coronary microvascular dysfunction. This study found higher Fib-4 scores correlated with reduced myocardial perfusion reserve index (MPRI) in patients without prior heart disease.
Area of Science:
- Cardiology
- Hepatology
- Medical Imaging
Background:
- The heart-liver axis is increasingly recognized for its clinical significance.
- Previous research indicates links between liver dysfunction/fibrosis and adverse cardiac events, but underlying mechanisms are unclear.
- Hepatic disease is known to associate with coronary microvascular dysfunction.
Purpose of the Study:
- To investigate the relationship between the degree of hepatic fibrosis, assessed by the Fibrosis-4 (Fib-4) risk score, and subclinical cardiac disease.
- To explore potential mechanistic pathways connecting liver fibrosis and cardiac dysfunction using cardiac MRI (CMR).
Main Methods:
- Retrospective single-center cohort study (2011-2021) of patients undergoing comprehensive CMR.
- Included patients lacked pre-existing cardiovascular disease or CMR perfusion abnormalities.
- Examined associations between Fib-4 scores and CMR measures, prioritizing the myocardial perfusion reserve index (MPRI), adjusting for cardiometabolic traits.
Main Results:
- Higher Fib-4 scores were significantly associated with a reduction in MPRI (P=0.02), indicating impaired coronary microvascular function.
- No significant associations were found between Fib-4 scores and other CMR measures of cardiac remodeling, inflammation, fibrosis, or dysfunction.
- The primary finding links hepatic fibrosis to coronary microvascular dysfunction, independent of other cardiac parameters.
Conclusions:
- Hepatic fibrosis, as indicated by the Fib-4 score, is associated with coronary microvascular dysfunction.
- This association may represent a key precursor pathway in the development of heart-liver disease.
- Further research is warranted to elucidate the specific mechanisms underlying this connection.
Abstract:
The heart-liver axis is of growing importance. Previous studies have identified independent association of liver dysfunction and fibrosis with adverse cardiac outcomes, but mechanistic pathways remain uncertain. We sought to understand the relations between the degree of hepatic fibrosis identified by the Fibrosis-4 (Fib-4) risk score and comprehensive cardiac MRI (CMR) measures of subclinical cardiac disease. We conducted a retrospective single-center cohort study of patients between 2011 and 2021. We identified consecutive patients who underwent a comprehensive CMR imaging protocol including contrast enhanced with stress/rest perfusion, and lacked pre-existing cardiovascular disease or perfusion abnormalities on CMR. We examined the association of hepatic fibrosis, using the Fib-4 score, with subclinical cardiac disease on CMR while adjusting for cardiometabolic traits. Given known associations of hepatic disease and coronary microvascular dysfunction, we prioritized analyses with the myocardial perfusion reserve index (MPRI), a marker of coronary microvascular function. Of the 66 patients in our study cohort, 54 were female (81%) and the mean age was 53.7 ± 15.3 years. We found that higher Fib-4 was associated with reduction in the MPRI (β [SE] - 1.12 [0.46], P = 0.02), after adjusting for cardiometabolic risk factors. Importantly, Fib-4 was not significantly associated with any other CMR phenotypes including measures of cardiac remodeling, inflammation, fibrosis, or dysfunction. We found evidence that hepatic fibrosis associated with coronary microvascular dysfunction, in the absence of overt associations with any other subclinical cardiac disease measures. These findings highlight a potentially important precursor pathway leading to development of subsequent heart-liver disease.
