Liver Stiffness by Magnetic Resonance Elastography Is Associated With Increased Risk of Cardiovascular Disease in Patients With Non-alcoholic Fatty Liver Disease

Jung Gil Park; Jinho Jung; Kritin K. Verma; Min Kyu Kang; Egbert Madamba; Scarlett Lopez; Aed Qas Yonan; Amy Liu; Ricki Bettencourt; Claude Sirlin; Rohit Loomba

Disclosures

Aliment Pharmacol Ther. 2021;53(9):1030-1037. 

In This Article

Results

Baseline Characteristics

One hundred and five patients with NAFLD who underwent MRE and cardiac CT for coronary calcium were included in this study. Median interval of cardiac CT and MRE with MRI-PDFF was 4.0 days and not more than 6 months. The average age and body mass index were 54.9 years and 32.9 kg/m2 respectively. Thirty-seven (35.2%) patients had significant liver fibrosis, which was defined as MRE-stiffness ≥ 2.97 kPa. Fifty-two (49.5%) patients had CAC scans, with a median coronary artery calcium score of 121.0 [47.0–516.0]. The baseline characteristics of participants with and without CAC are shown in Table 1. Compared to those without CAC, patients with CAC were more likely to be older (50.0 [39.0–59.0] vs 63.0 [55.5–67.5], P < 0.001), more likely to have hypertension (48.1% vs 76.5%, P = 0.006), had higher FRS (1.0 [0.5–3.5] vs 6.0 [2.0–12.0], P < 0.001), had lower platelet counts (271.0 [221.0–317.0] vs 236.5 [192.5–274.0], P = 0.002), had higher HOMA-IR (5.3 [3.4–7.9] vs 7.0 [4.6–13.0], P = 0.016), had higher FIB-4 (0.8 [0.5–1.0] vs 1.3 [0.9–1.7], P < 0.001) and NFS (−1.6 ± 1.3 vs −0.4 ± 1.2, P < 0.001), and were more likely to have higher median MRE-stiffness (2.7 [2.4–3.0] vs 2.9 [2.4–3.6], P = 0.037) and significant fibrosis (defined as MRE-stiffness ≥2.97 kPa) (22.6% vs 48.1%, P = 0.012).

Association Between Liver Stiffness and CAC in Patients With NAFLD

The association between the presence of CAC and liver stiffness is shown in Table 2. In the unadjusted analysis, sex, age, FRS and liver stiffness were significant factors associated with the presence of CAC. In sex- and age-adjusted analysis, liver stiffness (aOR = 2.23, 95% confidence interval [CI] = 1.31–4.34, P = 0.007) independently associated with the presence of CAC (Figure 1A). In FRS-adjusted analysis, liver stiffness (aOR = 2.16, 95% CI = 1.29–4.09, P = 0.008) also independently associated with the presence of CAC (Figure 1B).

Figure 1.

Predicted probability of the presence of coronary artery calcification (defined as coronary artery calcium score >0) according to liver stiffness by magnetic resonance elastography in patient with non-alcoholic fatty liver disease (A) Sex and age-adjusted model, (B) Framingham risk score-adjusted model. The area covered by the prediction intervals is 95% confidence interval. MRE, magnetic resonance elastography

Association Between Significant Fibrosis and CAC in Patients With NAFLD

Significant fibrosis (defined as MRE-stiffness ≥ 2.97 kPa) independently associated with the presence of CAC in sex and age-adjusted analysis (aOR = 3.53, 95% CI = 1.29–10.48, P = 0.017, Figure 2) as well as in FRS-adjusted analysis (aOR = 3.21, 95% CI = 1.30–8.28, P = 0.013). In addition, the presence of CAC was more prevalent in patients with significant fibrosis than those without (67.6% vs 39.7%, P = 0.012, Figure 3).

Figure 2.

Odds ratio for the presence of coronary artery calcification (defined as coronary artery calcium score >0) in sex and age-adjusted and FRS-adjusted logistic analysis in patients with non-alcoholic fatty liver disease and significant fibrosis (defined as MRE ≥2.97 kPa). CAC, coronary artery calcification; FRS, Framingham risk score; MRE, magnetic resonance elastography

Figure 3.

Prevalence of the presence of coronary artery calcification (defined as coronary artery calcium score >0) in patients with non-alcoholic fatty liver disease according to significant fibrosis (defined as MRE ≥2.97 kPa). MRE, magnetic resonance elastography

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