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Published on: August 28, 2018
Detection of Coronary Artery Disease With Coronary Computed Tomography Angiography and Stress Testing in Candidates
Rishabh Tandon1, Dzhalal Agakishiev2, Rebecca L Freese3
1Cardiovascular Division, Department of Medicine, University of Minnesota Medical School.
Insights
Coronary artery disease (CAD) is common in liver transplant (LT) candidates. Coronary computed tomography angiography (CCTA) is effective for diagnosing CAD, enabling better cardiac care for LT patients.
Area of Science:
- Cardiology
- Transplant Medicine
- Radiology
Background:
- Cardiac complications are the primary cause of death and illness in liver transplant recipients.
- Guidelines now favor coronary computed tomography angiography (CCTA) over stress testing for coronary artery disease (CAD) assessment in LT candidates.
Purpose of the Study:
- To determine the prevalence and predictors of CAD using CCTA in LT candidates.
- To compare the effectiveness of CCTA versus stress testing for CAD detection.
Main Methods:
- A comparative study of adult LT candidates undergoing noninvasive CAD assessment between 2020 and 2023.
- Two cohorts were analyzed: stress testing (2020) and CCTA (2021-2023).
- Data included diagnostic rates, CAD prevalence, and coronary artery calcium (CAC) scores.
Main Results:
- CCTA was less likely to be nondiagnostic (2.2%) compared to stress testing (12.8%).
- CAD was diagnosed in 58.7% of patients via CCTA versus 3.5% via stress testing.
- Clinically actionable CAD (CAC >100) was found in 35.7% of patients on CCTA, with CAD burden associated with risk factors.
Conclusions:
- A significant prevalence of CAD, often nonobstructive, exists in LT candidates.
- CCTA is a feasible and effective first-line test for risk-based CAD evaluation in LT candidates.
- Identifying actionable CAD via CCTA improves opportunities for optimizing cardiac care in LT recipients.
Abstract:
Cardiac complications are the leading cause of morbidity and mortality in recipients of liver transplant (LT). Previous guidelines recommended stress testing to exclude coronary artery disease (CAD), although recent guidelines recommend coronary computed tomography angiography (CCTA). We aimed to assess the prevalence and predictors of CAD on CCTA and compare CCTA with stress testing in consecutive adult candidates for LT who underwent CAD noninvasive assessment between 2020 and 2023. Patients who underwent a stress test between January and December 2020 formed the stress cohort, and patients who underwent CCTA between January 2021 and September 2023 formed the CCTA cohort. There were 141 patients in the stress test cohort and 269 patients in the CCTA cohort. Stress test results were nondiagnostic or inconclusive in 18 patients (12.8%) whereas CCTA was nondiagnostic in 6 patients (2.2%). In patients evaluated with CCTA, mean coronary artery calcium (CAC) score was 332 ± 716 AU, with moderate or greater (>50%) stenosis in 33 patients (12.3%). New CAD was diagnosed in 158 patients (58.7%) using CCTA and in 5 patients (3.5%) using stress tests. Clinically actionable CAD (coronary artery calcium >100) on CCTA was present in 96 patients (35.7%). The number of CAD risk factors was associated with the presence of CAD on CCTA. In conclusion, there was a great burden of CAD, mainly nonobstructive, in a large cohort of candidates for LT who underwent CAD testing over a 4-year period. The current recommended risk-based evaluation of candidates for LT using CCTA as a first-line test was feasible and effective. Diagnosis of clinically actionable CAD on CCTA provides a vast opportunity for optimizing cardiac care in candidates for and recipients of LT.
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