Related Experiment Videos
Evaluation of ischemic heart disease in potential lung transplant recipients
C M Thaik1, M J Semigran, L Ginns
1Division of Cardiology, Brigham and Women's Hospital, Boston, Mass., USA.
Insights
Coronary angiography is useful for identifying coronary artery disease in lung transplant candidates, especially those with multiple risk factors or a history of heart disease. This helps ensure transplant suitability.
Area of Science:
- Cardiology
- Thoracic Surgery
- Transplantation Medicine
Background:
- Coronary artery disease (CAD) prevalence in lung transplant candidates is understudied.
- Detecting occult CAD is crucial due to limited donor organs.
Purpose of the Study:
- To evaluate the utility of coronary angiography in potential lung transplant recipients.
- To assess the correlation between risk factors and CAD in this population.
Main Methods:
- Retrospective analysis of 105 lung transplant candidates.
- Coronary angiography indications and findings were reviewed.
- Coronary risk assessment scores were utilized.
Main Results:
- 49% of patients underwent coronary angiography.
- Patients with >2 risk factors were more likely to undergo angiography (75% vs 9%).
- Two significant, unsuspected coronary lesions were found in asymptomatic patients.
Conclusions:
- Coronary angiography is valuable for asymptomatic candidates with multiple CAD risk factors.
- It aids in evaluating candidates with a history of symptomatic cardiovascular disease.
- Findings did not preclude any patient from lung transplant listing.
Background:
The prevalence of coronary artery disease in potential lung transplant recipients has not been extensively studied. Given the limited donor supply, a high degree of sensitivity for detecting occult disease is essential.
Methods:
This retrospective study examined both the clinical indications for coronary angiography and the extent of coronary arteriosclerotic disease in 105 consecutive potential lung transplant candidates.
Results:
Fifty-one patients (49%) underwent angiography to either exclude asymptomatic atherosclerosis (n = 46) or define the extent of known symptomatic ischemic heart disease (n = 5). The perceived risk of occult disease according to a semiquantitative coronary risk assessment score that included hypertension, hyperlipidemia, diabetes, smoking, a family history of coronary artery disease, and electrocardiographic or echocardiographic abnormalities influenced the decision to perform angiography: 4 of 44 patients (9%) with two or fewer risk factors underwent angiography versus 42 of 56 patients (75%) with more than two risk factors (p < or = 0.05). A higher risk factor score also correlated with angiographic evidence of coronary artery disease. In the 46 patients without symptoms who were studied, two hemodynamically significant but unsuspected coronary lesions were identified. Six other patients without symptoms had noncritical (< 50%) lesions. Among the five patients with angina or a prior myocardial infarction, coronary angiography showed either minimal atherosclerosis (n = 2) or non-life threatening anatomy (n = 3). Angiographic findings did not exclude any patient from transplant listing.
Conclusion:
Coronary angiography appears most useful in patients without symptoms with multiple coronary risk factors and in a subset of patients who might otherwise be excluded from lung transplantation because of a history of symptomatic cardiovascular disease.