The Role of Coronary Artery Calcium Score and Age in Early Identification of Occult Coronary Artery Disease among Patients Undergoing Liver Transplant Work-up for End-stage Liver Disease

Taydas, Eren; Malik, Mohammad; Russell, Stuart; Latt, Nyan L.; Gürakar, Ahmet

doi:10.14309/00000434-201310001-00500

Cited by 5 publications

(8 citation statements)

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“…The presence of cardiac risk factors has also been shown to increase the possibility of a higher score . The available evidence suggests this test as promising and perhaps more reliable for the future …”

Section: Discussionmentioning

confidence: 99%

Dobutamine stress echocardiography, myocardial perfusion scintigraphy, invasive coronary angiography, and post‐liver transplantation events: Systematic review and meta‐analysis

Soldera

Camazzola

Rodríguez

et al. 2018

Clinical Transplantation

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The impact of coronary artery disease on the clinical course of patients enrolled for liver transplantation (LT) has changed over the years as these patients become older and sicker. The purpose of this systematic review and meta-analysis was to investigate the value of dobutamine stress echocardiography (DSE), myocardial perfusion scintigraphy (MPS), and invasive coronary angiography (ICA) in predicting cardiac events post-LT in cirrhotic patients. A literature search was conducted using Scopus, Web of Science, EMBASE, MEDLINE (via PubMed), BIREME (regional medical library of the Pan American Health Organization), LILACS (Latin American and Caribbean Health Sciences Literature), Cochrane Library for Systematic Reviews, and OpenGrey Repository (www.opengrey.eu) electronic databases. A total of 322 records were retrieved for DSE, 90 for MPS, and 149 for ICA. In the final analysis, 11 records for DSE, 7 for MPS, and 8 for ICA were included. The relative risk and confidence interval for major adverse cardiac events were 30.2 (2.8-325.4) for DSE, 2.6 (1.09-6.1) for MPS, and 2.1 (1.0-2.3) for ICA, while the relative risk and confidence interval for all-cause mortality was 4.7 for DSE (1.8-12.0), 2.7 (1.25-5.9) for MPS, and 1.5 (0.89-3.2) for ICA. In conclusion, this meta-analysis found that DSE, MPS, and ICA do not satisfactorily predict increased risk of perioperative MACE or all-cause mortality among cirrhotic patients listed for LT, among small and heterogenous studies.

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Section: Discussionmentioning

confidence: 99%

Dobutamine stress echocardiography, myocardial perfusion scintigraphy, invasive coronary angiography, and post‐liver transplantation events: Systematic review and meta‐analysis

Soldera

Camazzola

Rodríguez

et al. 2018

Clinical Transplantation

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“…9 Two studies have demonstrated relations between ECGgated CT scans and cardiac catheterization findings in OLT candidates. 19,20 These studies used only Agatston scores to evaluate patients and were limited in terms of sample size. Data from coronary CT angiography have shown a prognostic value similar to DSE and carry the additional risk of contrast dye.…”

Section: Discussionmentioning

confidence: 99%

“…Based on a starting point selected by a random number generator, charts were reviewed for the presence of a non− ECG-gated chest CT performed before coronary angiography during the liver transplant workup. Based on the data from ECG-gated CT scans in the ESLD population, 20 it was determined that a sample size of 44 patients would be required to provide 80% power to detect a difference between those with and without obstructive CAD at an a of 0.05. To account for potential dropout from incomplete medical records and/or irretrievable CT images, the minimum target sample size was set at 50 patients.…”

Section: Methodsmentioning

confidence: 99%

“…18 Two studies have demonstrated an association between Agatston scores from electrocardiogram (ECG)-gated computed tomography (CT) scans and cardiac catheterization findings in liver transplant candidates. 19,20 No study to date has looked at the utility of non−ECG-gated CT scans in the preliver transplant population, which are routinely performed to exclude pulmonary pathology or metastatic disease. Little is known about the prognostic significance of CACS from nongated CT, although limited data have suggested it correlates well with ECG-gated studies.…”

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confidence: 99%

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Significance of Coronary Artery Calcium Found on Non–Electrocardiogram-Gated Computed Tomography During Preoperative Evaluation for Liver Transplant

West

Low

Bista

et al. 2019

The American Journal of Cardiology

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Guidelines to evaluate patients for coronary artery disease (CAD) during preoperative evaluation for orthotopic liver transplantation (OLT) are conflicting. Cardiac catheterization is not without risk in patients with end-stage liver disease. No study to date has looked at the utility of non−electrocardiogram-gated chest computed tomography (CT) in the preliver transplant population. Our hypothesis was that coronary artery calcium scores (CACSs) from chest CT scans ordered during the liver transplant workup can identify patients who would benefit from invasive angiography. Nine hundred and fifty-three patients who underwent coronary angiography as part of their OLT workup were considered. Charts were randomly selected and reviewed for the presence of a chest CT performed before coronary angiography during the OLT workup. Agatston and Weston scores were calculated. CACS results were compared with coronary angiography findings. Nine of 54 patients were found to have obstructive CAD by angiography. Receiver-operating characteristic analysis demonstrated that an Agatston score of 251 and a Weston score of 6 maximized sensitivity and specificity for detection of obstructive coronary disease. An Agatston score <4 or Weston score <2 excluded the presence of obstructive CAD; using these thresholds, 13 patients (24%) or 15 patients (28%), respectively, could have theoretically avoided catheterization without missing significant CAD. In conclusion, our data identify the strength of CACS in ruling out coronary disease in patients being evaluated for OLT. Calcium scoring from non−electrocardiogram-gated CT studies may be integrated into preoperative algorithms to rule out obstructive CAD and help avoid invasive angiography in this high-risk population.

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“…They found that a CCS above 250 can indicate that a patient may have early coronary disease, and these patients may benefit from further investigation with a cardiac catheterization. 12 …”

Section: Updates In Cardiac Clearance Prior To Liver Transplantationmentioning

confidence: 99%

Liver Transplantation Update: 2014

Doğan

Gürakar

2015

Euroasian Journal of Hepato-Gastroenterology

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The first liver transplantation (LT) was performed by Thomas E Starzl five decades ago, and yet it remains the only therapeutic option offering gold standard treatment for end-stage liver disease (ESLD) and acute liver failure (ALF) and certain early-stage liver tumors. Post-liver transplantation survival has also dramatically improved over the last few decades despite increasing donor and recipient age and more frequent use of marginal organs to overcome the organ shortage. Currently, the overall 1 year survival following LT in the United States is reported as 85 to 90%, while the 10 years survival rate is ~50% (). The improvements are mainly due to progress in surgical techniques, postoperative intensive care, and the advent of new immunosuppressive agents. There are a number of factors that influence the outcomes prior to transplantation. Since 2002, the model for end-stage liver disease (MELD) score has been considered a predicting variable. It has been used to prioritize patients on the transplant waiting list and is currently the standard method used to assess severity in all etiologies of cirrhosis. Hepatocellular carcinoma (HCC) is the most common standard MELD exception because the MELD does not necessarily reflect the medical urgency of patients with HCC. The criteria for candidates with HCC for receiving LT have evolved over the past decade. Now, patients with HCC who do not meet the traditional Milan (MC) or UCSF criteria for LT often undergo downstaging therapy I an effort to shrink the tumor size. The shortage of donor organs is a universal problem. In some countries, the development of a deceased organ donation program has been prevented due to socioeconomic, cultural, legal and other factors. Due to the shortage of cadaveric donors, several innovative techniques have been developed to expand the organ donor pool, such as split liver grafts, marginal- or extended-criteria donors, live donor liver transplantation (LDLT), and the use of organs donated after cardiac death. Herein, we briefly summarize recent advances in knowledge related to LT. We also report common causes of death after liver transplant, including the recurrence of hepatitis C virus (HCV) and its management, and coronary artery disease (CAD), including the role of the cardiac calcium score in identifying occult CAD.How to cite this articleDogan S, Gurakar A. Liver Transplantation Update: 2014. Euroasian J Hepato-Gastroenterol 2015;5(2):98-106.

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The Role of Coronary Artery Calcium Score and Age in Early Identification of Occult Coronary Artery Disease among Patients Undergoing Liver Transplant Work-up for End-stage Liver Disease

Cited by 5 publications

References 0 publications

Dobutamine stress echocardiography, myocardial perfusion scintigraphy, invasive coronary angiography, and post‐liver transplantation events: Systematic review and meta‐analysis

Dobutamine stress echocardiography, myocardial perfusion scintigraphy, invasive coronary angiography, and post‐liver transplantation events: Systematic review and meta‐analysis

Significance of Coronary Artery Calcium Found on Non–Electrocardiogram-Gated Computed Tomography During Preoperative Evaluation for Liver Transplant

Liver Transplantation Update: 2014

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