Hepatic steatosis assessed by transient elastography in patients with significant coronary artery disease: a cross-sectional study

While metabolic dysfunction-associated steatotic liver disease (MASLD) and coronary artery disease (CAD) share metabolic risk factors, it remains unclear whether the anatomical severity of CAD predicts the severity of hepatic steatosis or fibrosis. This study aimed to estimate MASLD prevalence using FibroScan ® in patients with angiographically confirmed significant CAD and generate preliminary effect size estimates for associations between metabolic parameters and angiographic severity (SYNTAX score) with MASLD severity. In this pilot cross-sectional study, we enrolled 55 consecutive patients with ≥ 70% coronary stenosis undergoing angiography at Farshchian Hospital, Hamadan, Iran (2018–2019). All participants underwent abdominal ultrasound and transient elastography (FibroScan ® ) for controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) within four weeks post-discharge. CAD severity was quantified using the SYNTAX score. Although modest in size ( n = 55), post-hoc power analysis confirmed 98.7% power to detect the primary BMI–S3 steatosis association but only 12.3% power for SYNTAX–MASLD analyses. Participants were predominantly male (61.8%) with mean age 61.1 ± 8.9 years. FibroScan ® detected hepatic steatosis in 76.4% of patients that significantly higher than ultrasound detection (52.7%, P < 0.001). Critically, 50% of ultrasound-normal patients had steatosis by CAP. Severe steatosis (S3) occurred exclusively in patients with BMI ≥ 25 kg/m² ( P = 0.002; 98.7% power). No significant association emerged between SYNTAX score severity (low/intermediate vs. high) and severe steatosis (35.3% vs. 25.0%; P = 0.570) or advanced fibrosis (2.0% vs. 0%; P = 0.927); however, the 12.3% power for this analysis renders findings inconclusive rather than evidence of true null effect. In this study, MASLD prevalence was high and strongly associated with elevated BMI, while SYNTAX score associations could not be reliably assessed due to limited statistical power. These preliminary findings suggest that metabolic risk profiling, particularly adiposity assessment, may offer a more efficient approach than angiography-guided screening for MASLD detection in CAD patients, though validation in larger, multicenter cohorts with comprehensive metabolic phenotyping (including waist circumference) is required.