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Published on: November 7, 2020
Cardiac stress testing and coronary artery disease in liver transplantation candidates: Meta-analysis
Jonathan Soldera1, Fábio Camazzola1, Santiago Rodríguez2
1School of Medicine, Universidade de Caxias do Sul (UCS), Caxias do Sul 95070-560, Brazil.
Insights
Dobutamine stress echocardiography (DSE) and myocardial perfusion scintigraphy (MPS) show low sensitivity for detecting coronary artery disease (CAD) in liver transplant candidates. While specific, these tests are insufficient for ruling out CAD in this population.
Area of Science:
- Cardiology
- Hepatology
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) is a significant concern in patients with cirrhosis awaiting liver transplantation (LT).
- Non-invasive diagnostic tests are crucial for assessing CAD risk before LT.
Purpose of the Study:
- To evaluate the diagnostic accuracy of dobutamine stress echocardiography (DSE) and myocardial perfusion scintigraphy (MPS) for predicting CAD.
- To compare DSE and MPS against invasive coronary angiography (ICA) as the gold standard in cirrhotic patients.
Main Methods:
- Systematic literature search across multiple databases (Scopus, Web of Science, PubMed, etc.) without date or language restrictions.
- Manual searching of reference lists for relevant studies.
- Inclusion of 10 studies for DSE and 10 for MPS in the final meta-analysis.
Main Results:
- Pooled sensitivity for DSE was 28% and for MPS was 61%.
- Pooled specificity was 82% for DSE and 74% for MPS.
- Both DSE and MPS demonstrated significant specificity but inadequate sensitivity for CAD diagnosis.
Conclusions:
- Dobutamine stress echocardiography (DSE) and myocardial perfusion scintigraphy (MPS) lack sufficient sensitivity to reliably rule out coronary artery disease (CAD).
- Despite high specificity, these non-invasive tests are not adequate for determining the presence of CAD in patients with cirrhosis considered for liver transplantation.
Aim:
To evaluate the diagnostic value of dobutamine stress echocardiography (DSE) and myocardial perfusion scintigraphy (MPS) in predicting coronary artery disease (CAD) in cirrhotic patients listed for liver transplantation (LT), using invasive coronary angiography (ICA) as gold-standard.
Methods:
Retrieval of studies was based on Medical Subject Headings and Health Sciences Descriptors, which were combined using Boolean operators. Searches were run on the electronic databases Scopus, Web of Science, EMBASE, MEDLINE (PubMed), BIREME (Biblioteca Regional de Medicina), LILACS (Latin American and Caribbean Health Sciences Literature), Cochrane Library for Systematic Reviews and Opengray.eu. There was no language or date of publication restrictions. The reference lists of the studies retrieved were searched manually.
Results:
The search strategy retrieved 322 references for DSE and 90 for MPS. In the final analysis, 10 references for DSE and 10 for MPS were included. Pooled sensitivity was 28% and 61% for DSE and MPS and specificity was 82% and 74%, for diagnosis of CAD using ICA as gold-standard, respectively.
Conclusion:
DSE and MPS do not have adequate sensitivity for determination of whether CAD is present, despite having significant specificity.
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