Patients with cirrhosis have highly increased coronary arteriosclerosis

Background and aims: Cirrhosis is associated with the development of cardiac dysfunction and increased risk of sudden death which might be due to cardiac disease. However, the pathophysiological mechanism leading to cardiac dysfunction in cirrhosis is still not fully elucidated. Coronary artery calcium (CAC) score is a robust marker of the coronary atherosclerotic burden and also predict risk of cardiovascular disease (CVD) related events. The purpose of this study was to assess the prevalence of CAC in relation to cardiac dysfunction in patients with various stages of cirrhosis. Methods: Fifty-five patients with cirrhosis and without CVD were prospectively enrolled and underwent coronary CT angiography, echocardiography with tissue Doppler imaging, ECG, measurement of the hepatic venous pressure gradient (HVPG) and registration of clinical and biochemical characteristics. 59.6% of the patients were smoking. 12.7% had Child Pugh (CP) A, 74.5% with B and 12.7% with CP grade C. Results: The overall cohort had a very high CAC score compared to age and race adjusted reference value with a median CAC score of 332 (reference: 9) for men and of 90 (reference: 0) for women, respectively. Furthermore, CAC score was associated with a change in diastolic function (E-lateral reduced by: 13.4%, p = 0.048), which might further progress to affect left atrial (LA) diameter (LA diameter increased by: 8.4%, p = 0.087). However, we did not find any significant correlation between CAC score and CP score, MELD score or HVPG. Furthermore, we did not find any significant association to the well-known risk factors such as age, diabetes, hypertension, smoking and hypercholesterolemia. Conclusion: Patients with cirrhosis have more severe coronary arteriosclerosis compared to the general population, which might contribute to the development of changes in diastolic function and atrial enlargement. Coronary arteriosclerosis was not related to severity of cirrhosis or known risk factors. Future studies should reveal the pathophysiologic mechanism for CVD in patients with cirrhosis.