The Impact of MAFLD on Coronary Plaque Characteristics and Physiologic Status: A Coronary CT Angiography Study

Metabolic dysfunction-associated fatty liver disease (MAFLD) is linked to an increased risk of cardiovascular events. Our study sought to determine the impact of MAFLD on both the anatomy and function of coronary plaques.

A total of 203 participants (including 728 plaques) with suspected coronary artery disease (CAD) who underwent coronary CT angiography (CCTA) and abdominal ultrasound were prospectively enrolled. Participants were divided into MAFLD and non-MAFLD groups. For each plaque, necrotic core plaque volume and fractional flow reserve derived from CT (FFR_CT) were measured. Obstructive CAD, segment involvement score (SIS) >4, high-risk plaque (HRP) and FFR_CT ≤ 0.8 were assessed.

Compared to non-MAFLD, necrotic core plaque volume was higher in MAFLD at both participant level (p < 0.001) and plaque level (p = 0.001). MAFLD had a higher prevalence of obstructive CAD, SIS >4, HRP and FFR_CT ≤ 0.8 at participant level (obstructive CAD: 35.9% vs 21.6%, p = 0.026; SIS >4: 39.7% vs 17.6%, p < 0.001; HRP: 55.1% vs 29.6%, p < 0.001; FFR_CT ≤0.8: 33.3% vs 15.2%, p = 0.002). In addition, MAFLD predicted the presence of obstructive CAD (adjusted OR: 2.44; 95% CI: 1.22-4.87; p = 0.011), SIS >4 (adjusted OR: 3.64; 95% CI: 1.78-7.46; p < 0.001), HRP (adjusted OR: 2.52; 95% CI: 1.37-4.63; p = 0.003) and FFR_CT ≤ 0.8 (adjusted OR: 3.53; 95% CI: 1.65-7.57; p = 0.001) independent of traditional cardiovascular risk factors.

MAFLD is associated with CCTA derived plaque characteristics, including the severity and extent of CAD, HRP, as well as physiologic status, independent of traditional risk factors.