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Coronary multidetector computed tomographic angiography to evaluate coronary artery disease in liver transplant
Aoife N Keeling1, James D Flaherty, Amir H Davarpanah
1Division of Cardiovascular Imaging, Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA.
Insights
Coronary artery disease (CAD) is common in liver transplant candidates. Coronary multidetector computed tomographic angiography (MDCTA) is a feasible method to detect this asymptomatic CAD.
Area of Science:
- Cardiology
- Radiology
- Transplantation Medicine
Background:
- Coronary artery disease (CAD) poses significant risks for patients undergoing orthotopic liver transplantation (OLT).
- Standard ischemia detection methods can be unreliable in OLT candidates, who may also have contraindications for cardiac catheterization.
Purpose of the Study:
- To evaluate the feasibility and diagnostic yield of coronary multidetector computed tomographic angiography (MDCTA) for detecting coronary artery disease (CAD) in OLT candidates without a prior history of CAD.
Main Methods:
- Sixty-five OLT candidates without known CAD underwent coronary MDCTA.
- Coronary arteries were analyzed for lesion severity, morphology, extent, and consistency by two blinded reviewers.
- Image quality was assessed using a four-point Likert scale.
Main Results:
- Coronary MDCTA provided good or excellent image quality in 73.8% of cases.
- Asymptomatic CAD was prevalent, with 9% having normal arteries, 58% mild CAD, and 34% moderate to severe CAD.
- Plaque severity and burden were notably high in this cohort.
Conclusions:
- Asymptomatic CAD is highly prevalent among OLT candidates.
- Coronary MDCTA is a feasible and valuable tool for diagnosing occult CAD in this specific patient population.
Aims:
In patients undergoing orthotopic liver transplantation (OLT), coronary artery disease (CAD), obstructive and nonobstructive, is associated with high morbidity and mortality. In OLT candidates, stress testing for detecting ischemia is often inaccurate, and this patient population often has relative contraindications for cardiac catheterization. The objective of this study was to describe the methods, assess the feasibility and determine the extent and severity of CAD in OLT candidates without a prior history of CAD using coronary multidetector computer tomographic angiography (MDCTA).
Methods:
Sixty-five OLT candidates without known CAD underwent coronary MDCTA with dual source cardiac computed tomography (Siemens Definition). Coronary arteries were divided into 17 segments based on American Heart Association guidelines and evaluated independently by two blinded reviewers. Image quality of coronary MDCTA was assessed on a four-point Likert scale (0 = poor, 1 = fair, 2 = good, and 3 = excellent). Atherosclerotic lesions were evaluated for severity [mild (0-50%), moderate (51-70%), and severe (71-100%)], morphology, extent, location and consistency.
Results:
Image quality was graded as good or excellent in 73.8%. In this cohort of OLT candidates without known CAD, 9% had normal coronary arteries, 58% had mild CAD and 34% had moderate to severe CAD. Plaque severity and burden scores were high.
Conclusion:
The prevalence of asymptomatic CAD is high in OLT candidates. Coronary MDCTA is feasible in OLT candidates and appears to be a useful technique to diagnose occult CAD in this patient population.
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