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High burden of coronary atherosclerosis in patients with cirrhosis
Author(s) -
Kazankov Konstantin,
Munk Kim,
Øvrehus Kristian Altern,
Jensen Jesper Møller,
Siggaard Cecilie Brøckner,
Grønbæk Henning,
Nørgaard Bjarne Linde,
Vilstrup Hendrik
Publication year - 2017
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12777
Subject(s) - medicine , interquartile range , cirrhosis , coronary artery disease , chest pain , cardiology , population , agatston score , coronary artery calcium , environmental health
Background Population studies report increased cardiovascular mortality in patients with cirrhosis. Coronary artery disease may be a trait of end‐stage liver disease, but whether it is frequent or extensive in cirrhosis in general is unknown. Thus, we aimed to assess the prevalence and extent of coronary artery disease in unselected cirrhosis patients. Materials and methods Using coronary computed tomography angiography, we investigated 52 patients from all Child‐Pugh classes and aetiologies of cirrhosis without known cardiac disease for presence and severity of coronary artery disease in a cross‐sectional design. Persons referred with new‐onset chest pain served as controls. Results The prevalence of coronary artery disease was not significantly different between cirrhosis patients and controls (77% vs. 65%, P =0·19). However, cirrhosis patients had a markedly higher coronary artery calcification (Agatston) score than controls (120 [interquartile range, 0–345] vs. 5 [interquartile range, 0–86] HU , P =0·001). Likewise, patients with cirrhosis had a higher prevalence of extensive (≥5 coronary segments involved; 45% vs. 18%, P =0·01) and multivessel coronary disease (≥2 vessels involved; 75% vs. 53%, P =0·02). Furthermore, the total plaque volume whether noncalcified or calcified was higher in cirrhosis (117 [interquartile range, 0–310] vs. 36 [interquartile range, 0–148] mm 3 , P =0·02). Conclusion Coronary artery disease is equally prevalent in patients with cirrhosis and subjects with new‐onset chest pain, but cirrhosis patients have more extensive and severe disease including several coronary high‐risk features associated with myocardial ischaemia and a poor clinical outcome. The potential of preventive measures for coronary artery disease in cirrhosis needs attention.