The diagnostic and prognostic utility of risk factors defined by the AHA/ACCF on the evaluation of cardiac disease in liver transplantation candidates

Abstract

Background The diagnostic and prognostic utility of risk factors proposed by the 2012 American Heart Association and American College of Cardiology Foundation (AHA/ACCF) Scientific Statement on the cardiac assessment of asymptomatic liver transplantation candidates have not been validated. We investigated whether the sum of risk factors proposed by the AHA/ACCF can identify liver transplant candidates at increased cardiac risk. Methods In a retrospective cohort of consecutive liver transplantation recipients, we calculated, for each subject, the pre-transplantation sum of AHA/ACCF risk factors (age > 60 years, prior cardiovascular disease, hypertension, dyslipidemia, diabetes mellitus, smoking, and left ventricular hypertrophy). The primary outcome was the presence of severe coronary artery disease (CAD), defined as ≥70% stenosis or ≥ 50% left main stenosis on pre-transplantation angiography. The secondary outcomes were the composite of cardiac death or myocardial infarction (MI) and the composite of cardiac death, MI, or coronary revascularization. Results Among 220 liver transplant recipients, the sum of AHA/ACCF risk factors had good discriminatory capacity for severe CAD [area under the curve, 0.77; 95% confidence interval (CI), 0.62–0.92; P = 0.007]; having ≥3 risk factors provided 75% sensitivity and 77% specificity for severe CAD. During mean post-transplantation follow-up of 48 ± 31 months, having ≥3 risk factors was associated with increased risk of the secondary composite outcomes of cardiac death or MI [hazard ratio, 2.39; P = 0.044] and cardiac death, MI, or coronary revascularization [hazard ratio, 2.39; P = 0.044]. Conclusions In patients undergoing cardiac assessment prior to liver transplantation, the sum of risk factors proposed by the AHA/ACCF provides significant diagnostic and prognostic utility. Having ≥3 AHA/ACCF risk factors is a reasonable threshold to prompt non-invasive stress testing in asymptomatic liver transplantation candidates.

miRNA-22 as a Candidate Diagnostic Biomarker for Coronary Slow Flow

“…We retrospectively analyzed the data of 1256 patients who underwent elective coronary angiography from March 2018 to March 2019 at the Department of Internal Medicine of the Xiangya Hospital. e inclusion criteria of this study were patients who either did not have visually estimated coronary artery stenosis or had <50% stenosis, which was defined as insignificant coronary artery stenosis, being consistent with many other studies [18,19].…”

“…We retrospectively analyzed the data of 1256 patients who underwent elective coronary angiography from March 2018 to March 2019 at the Department of Internal Medicine of the Xiangya Hospital. The inclusion criteria of this study were patients who either did not have visually estimated coronary artery stenosis or had <50% stenosis, which was defined as insignificant coronary artery stenosis, being consistent with many other studies [ 18 , 19 ]. The following exclusion criteria were used: (1) acute coronary syndrome; (2) patients who underwent percutaneous coronary intervention or thrombolysis and patients with coronary artery ectasia or spasms; (3) other organic heart diseases such as cardiomyopathy, severe valvular heart disease, congenital heart disease, or severe cardiac insufficiency; (4) comorbid severe hepatic or renal impairment; (5) comorbid infection; (6) comorbid systemic inflammatory disorder; and (7) comorbid malignancy.…”

Abdominal Organ Transplantation: Noteworthy Literature in 2019

“…� Cardiac testing before liver transplantation: Alexander et al 47 Having 3 or more of the 2012 AHA/ACCF risk factors is an appropriate threshold to justify noninvasive stress testing prior to LT in patients without cardiac symptoms. � Liver transplantation without fresh frozen plasma: Hartmann et al 50 In this retrospective single-center review of 30-day outcomes of 372 LT patients managed by factor concentrates without fresh frozen plasma, neither fibrinogen concentrates nor PCC were identified as independent risk factors for 30-day mortality.…”

“…46 Alexander and colleagues tried to validate the diagnostic and prognostic utility of risk factors proposed by the 2012 American Heart Association and American College of Cardiology Foundation (AHA/ACCF) Scientific Statement on the cardiac assessment of asymptomatic LT candidates by conducting a retrospective cohort study of consecutive LT recipients who had no cardiac symptoms from July 2006 to October 2013 at a single institution. 47 They identified 220 patients (38.6% female, mean age 55 + 11 years) who underwent LT and were followed for a mean of 4.0 + 1.3 years. The average number of AHA/ ACCF risk factors present prior to LT was 2.3 + 1.7.…”

“…They determined that having 3 or more of these risk factors is an appropriate threshold to justify noninvasive stress testing prior to LT in patients without cardiac symptoms. 47…”