Clinical utility of transient elastography for assessing prevalent coronary heart disease in individuals with type 2 diabetes mellitus

Objective This study evaluated the use of transient elastography (TE) to assess the severity of metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), in patients with type 2 diabetes mellitus (T2DM), with the aim of exploring the cross-sectional association between hepatic steatosis and prevalent coronary heart disease (CHD) in this population. Methods A total of 104 patients with T2DM were included. TE measurements were obtained using FibroScan ® (Paris, France) to determine liver stiffness values, reflecting the degree of hepatic fibrosis, and the controlled attenuation parameter (CAP), which quantifies hepatic steatosis. The presence of CHD was evaluated by coronary computed tomography angiography (CTA), with invasive coronary angiography reserved for definitive confirmation in cases with CTA findings suggestive of significant stenosis. Statistical analyses comprised univariate and multivariate logistic regression models, along with receiver operating characteristic (ROC) curve analysis. The events-per-variable ratio was approximately 10. Internal validation was performed using 1,000-fold bootstrap resampling. Results Based on coronary CTA findings, patients were categorized into a CHD group (*n* = 50) and a non-CHD group (*n* = 54). Both univariate and multivariate logistic regression analyses identified CAP values (*p* < 0.001) and glycosylated hemoglobin (HbA1c) levels (*p* < 0.001) as variables independently associated with prevalent CHD among patients with T2DM. The area under the ROC curve (AUC) for CAP in discriminating CHD status was 0.828, whereas the AUC for HbA1c was 0.695. Combined analysis of CAP and HbA1c yielded an AUC of 0.848. Although the absolute increase in AUC was modest, integrated discrimination improvement (IDI = 0.023, *p* = 0.038) and category‑free net reclassification improvement (NRI = 0.186, *p* = 0.041) indicated meaningful reclassification of CHD status, supporting the incremental value of the combined model. Conclusions CAP, a quantitative indicator reflecting MASLD severity, is strongly associated with prevalent CHD in patients with T2DM. The combined assessment of CAP and HbA1c enhances the accuracy of CHD status discrimination in this population.