Liver stiffness as a cornerstone in heart disease risk assessment

Abstract

Metabolic dysfunction‐associated steatotic liver disease (MASLD) typically presents with hepatic fibrosis in advanced disease, resulting in increased liver stiffness. A subset of patients further develops liver cirrhosis and hepatocellular carcinoma. Cardiovascular disease is a common comorbidity in patients with MASLD and its prevalence is increasing in parallel. Recent evidence suggests that especially liver stiffness, whether or not existing against a background of MASLD, is associated with heart diseases. We conducted a narrative review on the role of liver stiffness in the prediction of highly prevalent heart diseases including heart failure, cardiac arrhythmias (in particular atrial fibrillation), coronary heart disease, and aortic valve sclerosis. Research papers were retrieved from major scientific databases (PubMed, Web of Science) until September 2023 using ‘liver stiffness’ and ‘liver fibrosis’ as keywords along with the latter cardiac conditions. Increased liver stiffness, determined by vibration‐controlled transient elastography or hepatic fibrosis as predicted by biomarker panels, are associated with a variety of cardiovascular diseases, including heart failure, atrial fibrillation, and coronary heart disease. Elevated liver stiffness in patients with metabolic liver disease should lead to considerations of cardiac workup including N‐terminal pro–B‐type natriuretic peptide/B‐type natriuretic peptide determination, electrocardiography, and coronary computed tomography angiography. In addition, patients with MASLD would benefit from heart disease case‐finding strategies in which liver stiffness measurements can play a key role. In conclusion, increased liver stiffness should be a trigger to consider a cardiac workup in metabolically compromised patients.

Ultrasound Shear Wave Elastography Evaluation of the Liver and Implications for Perioperative Medicine

“…Regardless of the classification scheme, an elevated liver stiffness in patients with either known steatotic liver disease or the presence of metabolic risk factors should trigger consideration for the evaluation of underlying cardiovascular disease [35]. As the population of patients with metabolic-related liver disease grows, ultrasound elastography evaluation of the liver will become more common, and it is essential that clinicians caring for these patients in the perioperative arena understand the significance of the relationship between an elevated liver stiffness and underlying cardiovascular disease.…”

“…The interaction between heart disease and liver disease is complex. Both share many risk factors, and several studies have shown that heart disease often accompanies elevated liver stiffness [35,[40][41][42]. A recent study evaluated the presence of subclinical heart disease in patients with non-advanced non-alcoholic fatty liver disease (NAFLD) [43].…”