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Author Spotlight: Enhancing Transplantation Research Through MicroCT Angiography in Murine Models
Published on: September 22, 2023
Coronary Computed Tomography Angiography (CTA) in the Diagnostic Triage of Patients Undergoing Liver Transplantation:
Pietro G Lacaita1, Armin Finkenstedt2, Thomas Senoner3
1Innsbruck Medical University, Department Radiology, Austria.
Insights
Coronary CTA effectively assesses cardiovascular risk in liver transplant candidates. Patients with no or minimal coronary artery disease on CTA have excellent survival outcomes, guiding transplantation decisions.
Area of Science:
- Cardiology
- Radiology
- Transplant Surgery
Background:
- Cardiovascular risk stratification is critical for patients with end-stage liver disease (ESLD) awaiting liver transplantation (LT).
- Optimal noninvasive methods for assessing this risk remain under investigation.
- Coronary computed tomography angiography (CTA) and coronary artery calcium (CAC) scoring are potential tools for risk stratification.
Purpose of the Study:
- To evaluate the prognostic value of coronary CTA and CAC scoring in patients undergoing LT.
- To determine the association of coronary artery disease (CAD) severity and plaque burden with mortality and myocardial infarction (MI) in this population.
Main Methods:
- Retrospective analysis of 270 patients undergoing LT who had pre-transplant coronary CTA and CAC scoring.
- Primary endpoint: all-cause mortality. Secondary endpoint: myocardial infarction (MI).
- Coronary CTA findings were categorized using CAD-RADS, and plaque burden was assessed. Statistical analysis included Kaplan-Meier and Cox regression.
Main Results:
- The majority of patients (69.8%) had CAD by CTA (CAD-RADS 1-5).
- All-cause mortality occurred in 17.0% of patients. Stenosis severity (CAD-RADS) and total plaque burden were associated with mortality (P < 0.001 and P = 0.029, respectively).
- CAC score was not associated with mortality. No MIs occurred in patients with CAD-RADS 0-1, while all MIs occurred in those with CAD-RADS 2-4.
Conclusions:
- Coronary CTA is a valuable tool for cardiovascular risk stratification in patients undergoing LT.
- Patients with no or minimal CAD on CTA demonstrate an excellent long-term prognosis.
- CTA findings, including stenosis severity and plaque burden, refine risk assessment for LT recipients.
Background:
Cardiovascular risk stratification is crucial in patients with end-stage liver disease (ESLD) yet the optimal noninvasive strategy remains debated. Our study aimed to assess the prognostic value of coronary computed tomography angiography (CTA) and coronary artery calcium (CAC) in patients undergoing orthotopic liver transplantation (LT).
Methods:
Patients with ESLD scheduled for LT referred to coronary CTA and the CACscore were included. The primary endpoint was all-cause mortality and the secondary endpoint was myocardial infarction (MI).
Results:
Four hundred fifty-eight patients for pre-LT risk stratification were enrolled with 270 LT recipients (79.3% male; mean age 61 ± 8.5 years) finally being included. The mean follow-up was 7.5 ± 3.1 years, range: 2-13. Among 248 patients undergoing CTA, the majority (n = 173, 69.8%) had coronary artery disease (CAD) by CTA (Coronary Artery Disease-Reporting and Data System[CAD-RADS] 1-5), and n = 75 (30.2%) had no CAD. Stenosis severity was minimal-to-mild (<50%) in 112 (45.1%), intermediate (50-70%) in 44 (17.7%), and severe (>70%) in 17 (6.5%) patients. The all-cause mortality rate was 46 (17.0%) (n = 3 cardiovascular). Stenosis severity (CAD-RADS) was associated with mortality (Kaplan-Meier analysis, P < 0.001). On multivariate Cox regression, total plaque burden were associated with all-cause mortality (hazard ratio [HR]: 1.1, P = 0.034; 95% confidence interval [CI]: 0.649-0.983 and HR: 1.1, P = 0.029; 95% CI: 1.0-1.6), while the CAC score was not. Six acute myocardial infarctions (MIs, 3 ST-elevation MI [STEMI] and 3 non-STEMI) occurred, none of them (0%) in patients with CAD-RADS 0-1 and 100% CAD-RADS 2-4.
Conclusion:
Coronary CTA is a valuable tool for pre-LT cardiovascular risk assessment. Patients with no or minimal CAD on CTA have an excellent prognosis regarding survival.
Clinical Relevance Statement:
Coronary CTA enables refined risk stratification in patients undergoing liver transplantation by assessing stenosis severity and plaque burden.
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