Myocardial perfusion imaging is an effective screening test for coronary artery disease in liver transplant candidates

Abstract

A reliable screening test for coronary artery disease (CAD) in liver transplant (LT) candidates with end-stage liver disease is essential because a high percentage of perioperative mortality and morbidity is CAD-related. In this study, the effectiveness of myocardial perfusion imaging (MPI) for identification of significant CAD in LT candidates was evaluated. Records of 244 patients meeting criteria for MPI were evaluated: 74 met inclusion criteria; 40 had a positive MPI and cardiology follow-up; 27 had a negative MPI and underwent LT; and seven had a negative MPI and then had coronary angiography or a significant cardiac event. A selective MPI interpretation strategy was established where MPI-positive patients were divided into high, intermediate, and low CAD risk groups. The overall incidence of CAD in this study population was 5.1% and our strategy resulted in PPV 20%, NPV 94%, sensitivity 80%, and specificity 50% for categorizing CAD risk. When applied only to the subset of patients categorized as high CAD risk, the strategy was more effective, with PPV 67%, NPV 97%, sensitivity 80%, and specificity 94%. We determined that renal dysfunction was an independent predictive factor for CAD (p < 0.0001, odds ratio = 8.1), and grades of coronary occlusion correlated significantly with chronic renal dysfunction (p = 0.0079).

Cardiac diseases among liver transplant candidates

“…Myocardial perfusion imaging with single‐photon emission computed tomography (SPECT) or positron emission tomography (PET) is not affected by β‐blocker therapy and detects CAD on the basis of differences in myocardial perfusion. When SPECT is used for the subset of LT candidates at high risk for CAD, the predictive values are excellent . Compared with SPECT, PET has better special and temporal resolution, facilitating the measurement of absolute myocardial blood flow and coronary vasodilator reserve.…”

“…When SPECT is used for the subset of LT candidates at high risk for CAD, the predictive values are excellent. 12 Compared with SPECT, PET has better special and temporal resolution, facilitating the measurement of absolute myocardial blood flow and coronary vasodilator reserve. Its attenuation correction reduces the number of artifacts, thereby increasing the specificity with less radiation exposure.…”

Preoperative Evaluation of Coronary Artery Disease in Liver Transplant Candidates: Many Unanswered Questions in Clinical Practice

“…The authors concluded that SPECT imaging was an inaccurate screening test, with its diagnostic ability to detect significant CAD equivalent to that of traditional CV risk factors. Nevertheless, Baker et al demonstrated that when applied only to the subset of patients categorized as high CAD risk, the modality was more effective, with PPV 67% and NPV 97% [ 29 ].…”

Coronary Computed Tomography Angiography in Combination with Coronary Artery Calcium Scoring for the Preoperative Cardiac Evaluation of Liver Transplant Recipients

“…The main advantage of coronary angiography is that it can be diagnosed and treated simultaneously with immediate percutaneous coronary intervention. With the lack of high-level evidence for the superiority of noninvasive tests, many centers rely on invasive coronary angiography [42]. Significant CAD is defined as a more than 50% decrease in the lumen diameter resulting in a hemodynamically significant reduction in coronary blood flow [43].…”