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Multicenter Study
. 2018 Mar;11(3):e007241.
doi: 10.1161/CIRCIMAGING.117.007241.

Association of Liver Fibrosis With Cardiovascular Diseases in the General Population: The Multi-Ethnic Study of Atherosclerosis (MESA)

Mohammad R Ostovaneh  1 , Bharath Ambale-Venkatesh  2 , Tomoki Fuji  1 , Hooman Bakhshi  1 , Ravi Shah  1 , Venkatesh L Murthy  1 , Russell P Tracy  1 , Eliseo Guallar  1 , Colin O Wu  1 , David A Bluemke  1 , João A C Lima  1
Affiliations
Multicenter Study

Association of Liver Fibrosis With Cardiovascular Diseases in the General Population: The Multi-Ethnic Study of Atherosclerosis (MESA)

Mohammad R Ostovaneh et al. Circ Cardiovasc Imaging. 2018 Mar.

Abstract

Background: The association of cardiovascular diseases (CVD) with liver fibrosis is poorly understood. We aim to assess the association of liver fibrosis by T1-mapping magnetic resonance imaging and CVD in MESA (Multi-Ethnic Study of Atherosclerosis).

Methods and results: MESA enrolled 6814 participants free of clinical CVD at baseline (2000-2002). A subsample of participants underwent T1-mapping magnetic resonance imaging 10 years after the baseline (Y10 MESA exam, 2010-2012). Liver T1 maps were generated avoiding vessels and biliary ducts from which native T1 (n=2087) and extracellular volume fraction (ECV, n=1234) were determined. Higher ECV and native T1 were indicators of liver fibrosis. Linear regression analysis evaluated the cross-sectional relationship between liver native T1 and ECV at Y10 MESA exam with a history of CVD events (atrial fibrillation, heart failure, and coronary heart disease [CHD]). Of the 2087 participants (68.7±9.1 years; 46% females), 153 had prior CVD events (78 atrial fibrillation, 25 heart failure, and 78 CHD). History of CVD events was associated with 18.5 ms higher liver native T1 (P<0.001) and 1.4% greater ECV (P=0.06). Prior atrial fibrillation was related to higher liver native T1 (β=21.1; P=0.001) and greater ECV (β=2.2; P=0.02), whereas previous heart failure was associated with greater liver ECV (β=4.1; P=0.02). There was also a relationship of prior CHD with liver native T1 (β=13; P=0.05) and ECV (β=1.9; P=0.05), which was attenuated by adjustment for coronary artery calcium score (β=7.1 and 1.6; P=0.37 and 0.13, respectively).

Conclusions: Liver fibrosis by T1-mapping magnetic resonance imaging is associated with history of heart failure, atrial fibrillation, and CHD in a multiethnic cohort. The association of liver fibrosis and CHD is at least in part mediated by atherosclerosis.

Keywords: cardiovascular diseases; fibrosis; inflammation; liver disease; population.

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Figures

Figure 1
Figure 1
The study flowchart
Figure 2
Figure 2
Association of liver native T1 time and liver ECV from T1 mapping MRI with liver fat content derived from water-fat Dixon MRI in a sub-sample of 36 participants.
Figure 3
Figure 3
Linear regression coefficients (CI95%) for association of liver native T1 time and liver ECV with previous history of CVD events (any type), AF, HF and CHD. Liver native T1 time and liver ECV were the independent variables in linear regression models and the regression coefficients represent the adjusted average difference in liver native T1 time or ECV in participants with previous history of CVD event compared to those without any event. Model 1 was adjusted for age, gender, race, income, alcohol use and risk factors at Y10 MESA exam with p<0.2 in univariable analysis; Model 2 was adjusted for variables in model 1 and left ventricular mass and volume index at the Y10 MESA exam; Model 3 was adjusted for variables in model 2 and coronary artery calcium score at the Y10 MESA exam
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