Abstract Body (Do not enter title and authors here):
Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) has been previously associated with coronary microvascular dysfunction (CMD) and is closely related to metabolic syndrome among men and women. Data regarding the association of quantitative liver steatosis and CMD in women with ischemia and no obstructive coronary arteries (INOCA) are scarce.

Aim: To evaluate the association of liver steatosis with myocardial perfusion in women with CMD and reference controls.

Methods: Women with CMD and no obstructive coronary arteries (n=55) from 2 prospective cohort studies (R01HL146158, R01HL153500) and asymptomatic age- and sex-matched reference controls (n=10) underwent stress and rest cardiac magnetic resonance imaging (MRI), with a validated MRI quantification of liver fat by proton density fat fraction (PDFF), at a single center. CMD was confirmed by coronary function testing or prior diagnostic stress tests. Parameters of liver fat and LV structure, function and myocardial perfusion reserve index (MPRI, a measure of CMD) were compared between cases and controls. A threshold of PDFF ≥5.2% was used to define significant liver steatosis.

Results: Other than higher prevalence of hypertension in the CMD group, age and cardiometabolic history were not significantly different between the groups, as were the PDFF and prevalence of liver steatosis (Table). PDFF directly correlated with body mass index (r=0.41, p<0.01). There was no correlation between PDFF and MPRI (Figure).

Conclusions: In this pilot study, our results suggest similar prevalence of liver steatosis between women with CMD and reference controls. Interestingly, MPRI did not correlate with PDFF, suggesting that mechanisms other than metabolic health may play a significant role in the pathophysiology of CMD among women with INOCA.