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Published on: September 15, 2023
Pre-Liver Transplant Coronary Artery Disease Workup for Low-Risk Patients
Jacentha Buggs1, Sadaf Aslam2, Chelsea Walker2
1Department of Transplant Surgery, Tampa General Medical Group, Tampa, FL, USA.
Insights
Coronary calcium score (CCS) is more accurate than dobutamine stress echocardiogram (DSE) for assessing coronary artery disease in liver transplant candidates. CCS showed higher predictive value despite poor agreement between the two cardiac risk assessment methods.
Area of Science:
- Cardiology
- Transplant Medicine
- Medical Imaging
Background:
- Coronary artery disease (CAD) is a significant cause of mortality post-liver transplant.
- Current pre-transplant cardiac assessment protocols for liver recipients lack standardization.
- Evaluating cardiac risk is crucial for improving outcomes in orthotopic liver transplant (OLT) patients.
Purpose of the Study:
- To assess the agreement between dobutamine stress echocardiogram (DSE) and coronary calcium score (CCS) for cardiac risk evaluation.
- To determine the predictive accuracy of DSE and CCS for coronary calcification in patients awaiting liver transplant.
- To identify the optimal non-invasive test for pre-liver transplant coronary artery disease assessment.
Main Methods:
- Retrospective analysis of 152 liver transplant candidates who underwent both DSE and CCS.
- Calculation of kappa coefficient to quantify agreement between DSE and CCS results.
- Analysis of positive predictive values (PPVs) of DSE and CCS compared to cardiac catheterization.
Main Results:
- A low agreement (12%) was observed between DSE and CCS results.
- Dobutamine stress echocardiogram (DSE) demonstrated a positive predictive value of 56%.
- Coronary calcium score (CCS) exhibited a higher positive predictive value of 80%.
Conclusions:
- There is a lack of agreement between DSE and CCS in assessing cardiac risk for liver transplant candidates.
- Neither DSE nor CCS is an optimal standalone method for pre-liver transplant cardiac risk assessment.
- Coronary calcium score (CCS) is a more accurate predictor of coronary calcification compared to DSE in this patient population.
Background:
Coronary artery disease (CAD) is a leading cause of mortality following orthotopic liver transplant, yet there is no standardized protocol for pre-liver-transplant coronary artery disease assessment. The main objective of this study was to determine the agreement between 2 methods of cardiac risk assessment: dobutamine stress echocardiogram (DSE) and coronary calcium score (CCS) and to determine which test was best able to predict coronary calcification in low-risk patients.
Methods:
A retrospective study was performed using the medical records of 436 patients who received cardiac clearance for a liver transplant. A total of 152 patients' medical records were included based on the inclusion of patients who had received both DSE and CCS. A kappa coefficient was calculated to determine the agreement between the DSE and CCS results. In addition, the positive predictive values (PPVs) of both the CCS and DSE along with cardiac catheterization indicating abdominal occlusion were analyzed to compare the accuracy of the 2 tests.
Results:
It was determined that there was a 12% agreement between DSE results and CCS. It was found that the DSE had a PPV of 56% and the CCS had a PPV of 80%.
Conclusion:
From this data, it was concluded that there was no agreement between the results of the CCS and the DSE. While neither the CCS nor the DSE presents an optimal method of risk assessment, the CCS had a much higher PPV and was therefore determined to be the more accurate test.
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