Cardiovascular Evaluation of Liver Transplant Patients by Using Coronary Calcium Scoring in ECG-Synchronized Computed...

Area of Science:

• Cardiology
• Transplantation Medicine
• Radiology

Background:

• Cardiac evaluation is crucial for patients awaiting orthotopic liver transplantation (OLT).
• Identifying patients at risk for cardiovascular events (CVEs) in the peri- and postoperative periods is essential.
• Coronary artery calcium (CAC) scoring in non-gated abdominal CTs offers opportunistic cardiac risk assessment.

Purpose of the Study:

• To evaluate if combining Lee's revised cardiac index (RCRI) and CAC scoring improves diagnostic accuracy for CVEs in OLT patients.
• To compare the prognostic impact of this combined method against standard non-invasive cardiac testing.

Main Methods:

• Retrospective evaluation of 169 patients undergoing OLT.
• Comparison of CVE prediction using RCRI and CAC scoring versus standard non-invasive cardiac testing.
• Analysis of negative predictive values (NPV) and positive predictive values (PPV) for CVEs.

Main Results:

• The combination of CAC and RCRI ≥ 2 demonstrated superior NPV (95.7%) and PPV (81.6%) for CVEs compared to standard tests (NPV 92.0%, PPV 54.5%).
• A CAC score > 0 was observed in 18 patients who experienced a CVE post-transplant.
• Standard workup identified 22 high-risk patients requiring interventions.

Conclusions:

• A CAC score > 0 combined with RCRI ≥ 2 is highly sensitive for identifying CVE risk in the OLT population.
• This combined approach enhances the identification of patients needing closer cardiac monitoring or intervention.
• Opportunistic CAC scoring on non-gated CTs can aid in preoperative cardiac risk stratification for OLT candidates.