Assessment of Vascular and Valvular Calcification Improves Screening for Coronary Artery Disease Before Liver...

Area of Science:

• Cardiology
• Hepatology
• Radiology

Background:

• Coronary artery disease (CAD) is prevalent in patients with cirrhosis evaluated for orthotopic liver transplantation (OLT).
• Stress echocardiography (echo) demonstrates limited sensitivity for detecting CAD in this population.
• Accurate pre-OLT CAD assessment is crucial for patient management and outcomes.

Purpose of the Study:

• To evaluate the impact of vascular and valvular calcification on identifying obstructive CAD prior to OLT.
• To determine if incorporating calcification data improves diagnostic performance beyond stress echo alone.

Main Methods:

• A case-control study involving 88 patients with obstructive CAD and 97 without, all undergoing OLT evaluation.
• All patients underwent preoperative stress echo, abdominal computed tomography (CT), and cardiac catheterization.
• Logistic regression models assessed CAD prediction using stress echo, vascular/valvular calcification from CT/echo, and clinical factors.

Main Results:

• Combining stress echo with vascular and valvular calcification assessment significantly improved CAD detection (AUC 0.73 vs 0.58, p <0.001).
• Further improvement was observed when age, gender, and insulin-dependent diabetes mellitus were included (AUC 0.80 vs 0.58, p <0.001).
• Achieving target heart rate or rate-pressure product did not enhance stress echo's diagnostic ability.

Conclusions:

• Routine preoperative CT and echo, assessing abdominal vascular, coronary artery, and valvular calcification, enhance CAD identification before OLT.
• This multimodal approach, including stress echo, offers superior diagnostic performance for obstructive CAD compared to stress echo alone in pre-OLT patients.
• Integrating calcification data improves the ability to identify and rule out obstructive CAD in this high-risk group.