PRO: Cardiac Catheterization Is the Optimal Strategy for Cardiovascular Risk Stratification in This Patient

Abstract

• Cardiovascular disease (CVD) represents one of the most common causes of post-liver transplant comorbidity and given the risk factors our patient has, presurgical optimization is critically important. • Noninvasive testing is unreliable and unproven in patients with cirrhosis, potentially providing a false sense of security to transplant programs managing the most complicated and vulnerable patients. • Modern cardiac catheterization is safe, and in this patient with preexisting cardiovascular risk factors set to be on lifelong immunosuppression, it is the optimal means for stratification. • Given the high stakes of transplant and the scrutiny on outcomes, programs should question the status quo of noninvasive testing and instead rely on the gold standard for cardiac risk stratification to provide the best outcomes for their patients. THis PaTienT is aT risK CVD is a leading cause of both long-and short-term complications after liver transplantation. 1,2 Given the importance of patient and graft survival, and the focus on the appropriate use of scarce resources, assessing a patient's cardiovascular risk and optimizing modifiable risk factors is critical. Multiple cardiovascular risk factors have prognostic and predictive value in identifying liver transplant patients at an increased cardiac risk. 3 Tools to better assess an individual patient's risk have been validated, including