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Published on: June 17, 2020
Cardiac evaluation of the kidney or liver transplant candidate
Paul Emile Levy1, Sadiya S Khan2, Lisa B VanWagner1,3,4
1Department of Medicine-Division of Gastroenterology and Hepatology.
Insights
Cardiac events are the leading cause of death after liver and kidney transplants. Advanced cardiac evaluation is crucial for older, sicker patients to assess cardiovascular risk before transplantation.
Area of Science:
- Cardiology
- Transplant Medicine
- Medical Imaging
Background:
- Cardiac events are the primary cause of death post-liver and kidney transplantation, surpassing graft failure and infection.
- Transplantation of older, sicker patients increases cardiovascular risk factors, necessitating refined cardiac evaluation protocols.
Purpose of the Study:
- To review current strategies for cardiac evaluation in liver and kidney transplant candidates.
- To highlight the shift towards advanced imaging techniques for assessing cardiovascular risk.
Main Methods:
- Computed tomography coronary angiography (CTCA) with coronary artery calcium (CAC) scoring is now the preferred method over stress imaging for coronary artery disease (CAD) assessment.
- Transthoracic echocardiography (TTE) with tissue Doppler imaging and strain imaging is recommended for evaluating cardiac structure and function.
Main Results:
- CTCA with or without CAC scoring is favored for CAD assessment in most transplant candidates.
- TTE with advanced imaging is particularly important for liver transplant candidates at risk of cirrhotic cardiomyopathy, with updated diagnostic criteria available since 2019.
Conclusions:
- Comprehensive cardiac evaluation is essential for both short- and long-term risk stratification in liver and kidney transplant candidates.
- Risk stratification must integrate anatomical and functional assessments of CAD and cardiac function.
Purpose Of Review:
As the field of transplant has advanced, cardiac events have become the leading cause of morbidity and mortality after liver and kidney transplantation ahead of graft failure and infection. This trend has been bolstered by the transplantation of older and sicker patients who have a higher burden of cardiovascular risk factors, accentuating the need to determine which patients should undergo more extensive cardiac evaluation prior to transplantation.
Recent Findings:
Computed tomography coronary angiography with or without coronary artery calcium scoring is now preferred over stress imaging in most transplant candidates for assessment of coronary artery disease. Assessment of cardiac structure and function using transthoracic echocardiography with tissue doppler imaging and strain imaging is recommended, particularly in liver transplant candidates who are at high risk of cirrhotic cardiomyopathy, for which new diagnostic criteria were recently published in 2019.
Summary:
Cardiac evaluation of liver and kidney transplant candidates requires a global assessment for both short and long-term risk for cardiac events. Imaging of cardiac structure and function using transthoracic echocardiography with tissue doppler imaging and strain imaging is recommended. Risk stratification should consider both the anatomic and functional consequences of coronary artery disease in transplant candidates.
Video Abstract:
http://links.lww.com/MOT/A27.
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