Routine Coronary Angiography is Still the Key Test for Patients Eligible for Lung Transplantation Also for Those With
Wojtek Karolak1, Krystyna Pastwa2, Salma Ali Addo2
1Department of Cardiac Surgery and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland.
Insights
Coronary artery disease (CAD) in lung transplant candidates is common and not predicted by risk factors. Coronary angiography is crucial for pre-transplant evaluation to assess stenosis and optimize patient selection.
Area of Science:
- Cardiology
- Thoracic Surgery
- Transplantation Medicine
Background:
- Coronary artery disease (CAD) significantly impacts lung transplant outcomes, necessitating pre-transplant evaluation.
- Current guidelines for cardiac angiography in lung transplant candidates are lacking.
- Optimizing patient selection for coronary angiography is essential.
Purpose of the Study:
- To investigate the correlation between cardiovascular risk scores and coronary arterial status in lung transplant candidates.
- To refine the selection criteria for pre-transplant coronary angiography.
Main Methods:
- Retrospective analysis of 48 patients undergoing coronary angiography and cardiac catheterization for bilateral lung transplantation (2018-2021).
- Classification of coronary artery disease status (stenosis vs. no stenosis).
- Estimation of 10-year cardiovascular risk using the Systematic COronary Risk Evaluation (SCORE) calculator.
Main Results:
- Coronary stenosis was identified in 31% (15/48) of patients.
- Both groups (with and without stenosis) exhibited high median SCORE risks (8% and 5%, respectively).
- Mean pulmonary artery pressure was similar in patients with and without coronary stenosis (23 mm Hg).
Conclusions:
- Pre-transplant cardiovascular risk factors do not reliably predict CAD in lung transplant candidates.
- Coronary angiography remains a critical component of the lung transplant evaluation process.
- Cardiac catheterization is vital for assessing pulmonary hypertension and guiding post-transplant management.
Background:
Coronary artery disease (CAD) has a considerable morbidity and mortality effect on the outcomes of a lung transplant. Currently, coronary angiography is performed as part of the pretransplant evaluation process. Unfortunately, there are no clear guidelines about performing cardiac angiography in lung transplant candidates.
Background:
The aim of our work is to find a correlation between cardiovascular risk and coronary arterial status to optimize the selection of patients for coronary angiography prior transplantation.
Methods:
We retrospectively analyzed 48 patients in whom coronary angiography and cardiac catheterization was performed during assessment for bilateral lung transplantation at the Medical University of Gdańsk from 2018 to 2021. The coronary artery disease status was classified into 2 categories: without any stenosis and with stenosis. For each patient, the 10-year cardiovascular risk was estimated by using a Systematic COronary Risk Evaluation calculator modified for the Polish population.
Results:
Coronary stenosis was detected in 15 patients during angiography (31%). The group with coronary stenosis had a median SCORE risk of 8%, which is considered as high risk, and in patients without stenosis it was 5%, which is also considered a high risk. Median mean pulmonary artery pressure in patients with stenosis was the same as that in patients without stenosis (23 mm Hg).
Conclusions:
CAD among lung transplant candidates cannot be predicted by risk factors, so coronary angiography is very important as a part of the evaluation process. Because pulmonary hypertension has a big impact on surveillance after transplantation, performing heart catheterization during the qualification process is crucial.
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