Abstract
Introduction: Fatty liver disease and liver fibrosis are associated with cardiovascular disease (CVD) metabolic risk factors and events. However direct imaging of liver abnormalities using T1 mapping MRI in relation to CVD has not been investigated in large epidemiological cohorts. Hypothesis: Liver abnormalities (inflammation and/or fibrosis) by T1 mapping MRI are associated with CVD events. Methods: MESA enrolled 6814 participants free of clinical CVD at baseline, MESA1 (2000-2002). A subsample of participants underwent Modified Look-Locker T1 mapping MRI at the fifth follow-up exam, MESA5 (2010 -2012). T1 maps were analyzed avoiding vessels and biliary ducts, and pre- and post-contrast T1 times (25 minutes after injection) were calculated. Liver extracellular volume fraction (ECV) was calculated using the pre- and post-contrast T1 times of the liver and cardiac blood pool. Higher ECV and pre-contrast T1 time (PreT1) were indicative of liver abnormalities. Coronary heart disease (CHD), heart failure (HF) and atrial fibrillation (AF) events were ascertained between MESA 1 and MESA 5. Multivariable linear regression analysis evaluated the cross-sectional relationship between liver ECV and T1 time with cardiac events adjusted for ASCVD/AHA risk score, liver fat content by computed tomography, alcohol use, socioeconomic status and BMI. Results: In 888 participants (67.83±8 years, 51% female, 60% Caucasian, 4% Chinese, 26% African-American, 10% Hispanic) there were 63 cardiac events (44 CHD, 13 CHF and 18 AF) between MESA1 and 5. Compared to controls, PreT1 and ECV were significantly higher in those with any cardiac event and AF. In multivariable analysis, PreT1 (standardized β=0.08, p=0.018) and ECV (standardized β=0.09, p=0.008) were associated with composite cardiac events. Conclusion: Liver abnormalities (most likely inflammation and/or fibrosis) estimated by greater liver PreT1 and ECV, are associated with cardiac events in a multi-ethnic cohort.
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