Subclinical hepatic fibrosis is associated with coronary microvascular dysfunction by myocardial perfusion reserve index: a retrospective cohort study

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...

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Published inThe international journal of cardiovascular imaging Vol. 38; no. 7; pp. 1579 - 1586
Main Authors Kwan, Alan C., Wei, Janet, Lee, Brian P., Luong, Eric, Salto, Gerran, Nguyen, Trevor-Trung, Botting, Patrick G., Liu, Yunxian, Ouyang, David, Ebinger, Joseph E., Li, Debiao, Noureddin, Mazen, Thomson, Louise, Berman, Daniel S., Merz, C. Noel Bairey, Cheng, Susan
Format Journal Article
LanguageEnglish
Published Dordrecht Springer Netherlands 01.07.2022
Springer Nature B.V
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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.
AbstractList 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.
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.
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.
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.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.
Author Merz, C. Noel Bairey
Luong, Eric
Li, Debiao
Cheng, Susan
Wei, Janet
Botting, Patrick G.
Berman, Daniel S.
Ebinger, Joseph E.
Lee, Brian P.
Kwan, Alan C.
Salto, Gerran
Nguyen, Trevor-Trung
Thomson, Louise
Noureddin, Mazen
Liu, Yunxian
Ouyang, David
AuthorAffiliation b Keck School of Medicine of USC, Department of Medicine
a Cedars Sinai Medical Center, Smidt Heart Institute Department of Cardiology, Barbra Streisand Women’s Heart Center, Biomedical Imaging Research Institute, Division of Digestive and Liver Diseases, and Department of Imaging, Los Angeles, CA
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Issue 7
Keywords Hepatic fibrosis
Coronary perfusion
Cardiac MRI
Language English
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Author Contributions: ACK: Conception, design, analysis, interpretation, drafting, review; JW: Conception, interpretation, review; BPL: Conception, design, interpretation, review; EL: Conception, acquisition, analysis, interpretation, review; GS: Conception, acquisition, analysis, review; TTN: Conception, acquisition, analysis, review; PGB: Design, analysis, interpretation, review; YL: Design, analysis, review; DO: Conception, design, interpretation, review; JEE: Conception, design, interpretation, review; DL: Conception, design, interpretation, review; MN: Conception, interpretation, review; LT: Conception, interpretation, review; DSB: Conception, acquisition, interpretation, review; CNB: Conception, acquisition, interpretation, review; SC: Conception, design, acquisition, analysis, interpretation, review. All authors have approved the final version and agree to accountability for author’s contributions.
ORCID 0000-0002-4977-036X
OpenAccessLink https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9343468
PMID 35107770
PQID 2688282507
PQPubID 43205
PageCount 8
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proquest_journals_2688282507
crossref_primary_10_1007_s10554_022_02546_7
pubmed_primary_35107770
springer_journals_10_1007_s10554_022_02546_7
PublicationCentury 2000
PublicationDate 2022-07-01
PublicationDateYYYYMMDD 2022-07-01
PublicationDate_xml – month: 07
  year: 2022
  text: 2022-07-01
  day: 01
PublicationDecade 2020
PublicationPlace Dordrecht
PublicationPlace_xml – name: Dordrecht
– name: United States
PublicationSubtitle X-Ray Imaging, Intravascular Imaging, Echocardiography, Nuclear Cardiology, Computed Tomography and Magnetic Resonance Imaging
PublicationTitle The international journal of cardiovascular imaging
PublicationTitleAbbrev Int J Cardiovasc Imaging
PublicationTitleAlternate Int J Cardiovasc Imaging
PublicationYear 2022
Publisher Springer Netherlands
Springer Nature B.V
Publisher_xml – sequence: 0
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Snippet The heart–liver axis is of growing importance. Previous studies have identified independent association of liver dysfunction and fibrosis with adverse cardiac...
The heart-liver axis is of growing importance. Previous studies have identified independent association of liver dysfunction and fibrosis with adverse cardiac...
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StartPage 1579
SubjectTerms Abnormalities
Blood platelets
Cardiac Imaging
Cardiology
Cardiovascular disease
Cardiovascular diseases
Cohort analysis
Coronary artery disease
Ejection fraction
Fibrosis
Health risks
Heart
Heart diseases
Imaging
Laboratories
Liver
Liver diseases
Magnetic resonance imaging
Medicine
Medicine & Public Health
Metabolism
Microvasculature
Original Paper
Patients
Perfusion
Phenotypes
Radiology
Risk analysis
Risk factors
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Title Subclinical hepatic fibrosis is associated with coronary microvascular dysfunction by myocardial perfusion reserve index: a retrospective cohort study
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Volume 38
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