Investigating the Association between Coronary Artery Disease and the Liver Fibrosis-4 Index in Patients Who Underwent Coronary Computed Tomography Angiography: A Cross-Sectional Study

Abstract

Liver fibrosis scores, indicative of hepatic scarring, have recently been linked to coronary artery disease (CAD). We investigated the association between CAD and the fibrosis-4 index (FIB-4I) in patients who underwent coronary computed tomography angiography (CCTA). This study included 1244 patients who were clinically suspected of having CAD. The presence or absence of CAD was the primary endpoint. FIB-4I was higher in the CAD group than in the non-CAD group (1.95 ± 1.21 versus [vs.] 1.65 ± 1.22, p < 0.001). FIB-4I was also higher in the hypertension (HTN) group than in the non-HTN group (1.90 ± 1.32 vs. 1.60 ± 0.98, p < 0.001). In all patients, high FIB-4I (≥2.67) was a predictor of presence of CAD (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.30-2.83, p = 0.001), and low FIB-4I (≤1.29) was proven to be a predictor of absence of CAD (OR: 0.65, 95% CI: 0.48-0.88, p = 0.006). In the HTN group, high and low FIB-4I levels, were found to be predictors for CAD (OR: 2.01, 95% CI: 1.26-3.21, p < 0.001 and OR: 0.65, 95% CI: 0.45-0.94, p < 0.022, respectively), in particular. FIB-4I may serve as a diagnostic indicator of the presence or absence of CAD in hypertensive patients undergoing CCTA.

Keywords: coronary artery disease; coronary computed tomography angiography; fibrosis-4 index; hypertension.

Figure 1

Comparative evaluation of FIB-4I values between the four groups. * p < 0.05, ** p < 0.01, and *** p < 0.001, according to the Kruskal-Wallis and Steel-Dwass tests. Group 1, HTN and CAD; Group 2, HTN without CAD; Group 3, without HTN with CAD; Group 4, without HTN and CAD; NS, not significant; CAD, coronary artery disease; HTN, hypertension; FIB-4I, fibrosis-4 index.

Figure 2

Comparative evaluation of the prevalence of CAD between the three groups. *** p < 0.001. Low FIB-4I, ≤1.29; intermediate FIB-4I, 1.30–2.66; high FIB-4I, ≥2.67; CAD, coronary artery disease; FIB-4I, fibrosis-4 index.

Figure 3

Comparative evaluation of the Gensini score between the three groups. ** p < 0.01 and *** p < 0.001 according to the Kruskal-Wallis and Steel-Dwass tests. CAD, coronary artery disease; FIB-4I, fibrosis-4 index.

Figure 4

Representative coronary computed tomography angiography images. (a) A 66-year-old man with no noticeable CAD, a FIB-4I level of 0.85, and a Gensini score of 0; and (b) A 78-year-old woman with a FIB-4I level of 3.13 and a Gensini score of 45, showing multiple coronary artery stenoses. CAD, coronary artery disease; LAD, left anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery.