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Pronounced Coronary Arteriosclerosis in Cirrhosis: Influence on Cardiac Function and Survival?

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Abstract

Background

The relation between excessive alcohol consumption and coronary arteriosclerosis has remained controversial. The etiology of cirrhosis has been considered a substantial risk factor for development of arteriosclerotic lesions. The coronary artery calcium-score derived from coronary CT angiography is a robust marker of coronary arteriosclerosis.

Aims

To study the burden of coronary arteriosclerosis in cirrhotic patients of various etiologies and association to cardiac dysfunction and survival.

Methods

Fifty-seven patients with cirrhosis without cardiovascular disease underwent coronary CT angiography, tissue Doppler echocardiography, electrocardiogram and registration of clinical and biochemical characteristics.

Results

In patients with cirrhosis the median coronary artery calcium-score was increased in comparison with age and race-adjusted healthy reference values (men: 328 vs. 9 HU and women: 136 vs. 0 HU; p < 0.001). Moreover, the coronary artery calcium-score in alcohol-related cirrhosis was significantly higher than in nonalcohol-related cirrhosis (362 vs. 46 HU, p < 0.001). Coronary artery calcium-score correlated with age (p = 0.002) but not with established cardiovascular risk factors including smoking, type 2 diabetes, hypertension, gender, or hypercholesterolemia. Coronary artery calcium-score was associated with diastolic dysfunction, lateral e´ (p = 0.025), but not with other markers of cardiac dysfunction. During a median follow-up of 25 months 12 patients (21%) died but coronary artery calcium-score was not associated with survival.

Conclusions

Coronary arteriosclerosis was particular extensive in patients with alcoholic cirrhosis. However, the current results suggest that coronary arteriosclerosis only have limited influence on cardiac function and survival. Surprisingly, no other established risk factors apart from age seemed to interfere with coronary arteriosclerosis in cirrhotic patients.

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Acknowledgments

We sincerely thank the staff at Centre for Functional and Diagnostic Imaging and Research, Hvidovre University Hospital for the effort. We thank Allan Poulsen and Hanne Halgreen for their impressive help with the echocardiography measurements and we also thank laboratory technician Katrine Lyngby for her excellent assistance. This project has received financial support and funds from Novo Nordisk Foundation and Amager Hvidovre University Hospital Research Foundation.

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Authors and Affiliations

  1. Centre for Functional and Diagnostic Imaging, Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, Hvidovre, Denmark

    Karen V. Danielsen, Signe Wiese & Søren Møller

  2. Centre for Gastroenterology and Hepatology, Department of medicine, Hvidovre Hospital, Hvidovre, Denmark

    Karen V. Danielsen, Signe Wiese & Flemming Bendtsen

  3. Department of Cardiology, Hvidovre Hospital, Copenhagen, Denmark

    Jens Hove

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  1. Karen V. Danielsen
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  2. Signe Wiese
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Correspondence to Karen V. Danielsen.

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Danielsen, K.V., Wiese, S., Hove, J. et al. Pronounced Coronary Arteriosclerosis in Cirrhosis: Influence on Cardiac Function and Survival?. Dig Dis Sci 63, 1355–1362 (2018). https://doi.org/10.1007/s10620-018-5006-7

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  • DOI: https://doi.org/10.1007/s10620-018-5006-7

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