Use of Computed Tomography Coronary Calcium Score for Coronary Artery Disease Risk Stratification During Liver Transplant Evaluation

Bhatti, Sabha; Lizaola-Mayo, Blanca; Al-Shoha, Mohammad; Garcia‐Saenz‐de‐Sicilia, Mauricio; Habash, Fuad; Ayoub, Karam; Karr, Michael; Ahmed, Zubair; Borja–Cacho, Daniel; Duarte‐Rojo, Andrés

doi:10.1016/j.jceh.2021.08.015

Cited by 9 publications

(5 citation statements)

References 44 publications

(46 reference statements)

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“…Previous studies in LT candidates suggest that either CCTA findings or a high CACS may identify patients at highest risk of CVE 33–36 . In our study, that included one of the largest cohorts of LT recipients with CACS, we also observed an independent association between pre‐LT CACS and post‐LT CVE, which were particularly incident in patients with CACS≥400.…”

Section: Discussionsupporting

confidence: 72%

“…Previous studies in LT candidates suggest that either CCTA findings or a high CACS may identify patients at highest risk of CVE. [33][34][35][36] In our study, that included one of the largest cohorts of LT recipients with CACS, we also observed an independent TA B L E 5 Uni-and multivariate Cox regression analysis of pre-transplant variables associated with the cumulative incidence of cardiovascular events among liver transplant (LT) recipients. association between pre-LT CACS and post-LT CVE, which were particularly incident in patients with CACS≥400.…”

Section: Discussionsupporting

confidence: 52%

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CACS, CCTA and mCAD‐LT score in the pre‐transplant assessment of coronary artery disease and the prediction of post‐transplant cardiovascular events

Pagano,

Sastre,

Blasi

et al. 2024

Liver International

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BackgroundThe optimal cardiovascular assessment of liver transplant (LT) candidates is unclear. We aimed to evaluate the performance of CT‐based coronary tests (coronary artery calcium score [CACS] and coronary CT angiography [CCTA]) and a modification of the CAD‐LT score (mCAD‐LT, excluding family history of CAD) to diagnose significant coronary artery disease (CAD) before LT and predict the incidence of post‐LT cardiovascular events (CVE).MethodsWe retrospectively analysed a single‐centre cohort of LT candidates who underwent non‐invasive tests; invasive coronary angiography (ICA) was performed depending on the results of non‐invasive tests. mCAD‐LT was calculated in all patients.ResultsSix‐hundred‐and‐thirty‐four LT candidates were assessed and 351 of them underwent LT. CACS, CCTA and ICA were performed in 245, 123 and 120 LT candidates, respectively. Significant CAD was found in 30% of patients undergoing ICA. The AUROCs of mCAD‐LT (.722) and CCTA (.654) were significantly higher than that of CACS (.502) to predict the presence of significant CAD. Specificity of the tests ranged between 31% for CCTA and 53% for CACS. Among patients who underwent LT, CACS ≥ 400 and mCAD‐LT were independently associated with the incidence of CVE; in patients who underwent CCTA before LT, significant CAD at CCTA also predicted post‐LT CVE.ConclusionIn this cohort, mCAD‐LT score and CT‐based tests detect the presence of significant CAD in LT candidates, although they tend to overestimate it. Both mCAD‐LT score and CT‐based tests classify LT recipients according to their risk of post‐LT CVE and can be used to improve post‐LT risk mitigation.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionsupporting

confidence: 52%

CACS, CCTA and mCAD‐LT score in the pre‐transplant assessment of coronary artery disease and the prediction of post‐transplant cardiovascular events

Pagano,

Sastre,

Blasi

et al. 2024

Liver International

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“…The increasing use of coronary calcium scores has led to the adoption of hybrid models using coronary calcium scoring and DSE [7]. Small studies have shown good negative predictive value with low calcium scores in this population [8 ▪ ]. In this study of 148 patients, no patients with a calcium score of less than 100 presented with an acute coronary syndrome posttransplant.…”

Section: Cad Risk Assessmentmentioning

confidence: 71%

Cardiac evaluation of the liver transplant candidate

Possick,

Khungar,

Deshpande

2023

Current Opinion in Organ Transplantation

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Purpose of review This review aims to summarize recent changes in the cardiac evaluation of adult liver transplant candidates. Over the last several years, there have been significant advances in the use of coronary computed tomography angiography (CCTA) with and without fractional flow reserve (FFR) and increasingly widespread availability of coronary calcium scoring for risk stratification for obstructive coronary artery disease. This has led to novel strategies for risk stratification in cirrhotic patients being considered for liver transplant and an updated American Heart Association (AHA) position paper on the evaluation of liver and kidney transplant candidates. The diagnosis of cirrhotic cardiomyopathy has been refined. These new diagnostic criteria require that specific echocardiographic parameters are evaluated in all patients. The definition of pulmonary hypertension on echocardiography has been altered and no longer utilizes right atrium (RA) pressure estimates based on inferior vena cava (IVC) size and collapse. This provides more volume neutral estimates of pulmonary pressure. Recent findings Although CCTA has outstanding negative predictive value, false positive results are not uncommon and often lead to further testing. Revised diagnostic criteria for cirrhotic cardiomyopathy improve risk stratification for peri-operative volume overload and outcomes. Refined pulmonary hypertension criteria provide improved guidance for right heart catheterization (RHC) and referral to subspecialists. There are emerging data regarding the safety and efficacy of TAVR for severe aortic stenosis in cirrhotic patients. Summary Increased utilization of noninvasive testing, including CCTA and/or coronary calcium scoring, can improve the negative predictive value of testing for obstructive coronary artery disease and potentially reduce reliance on coronary angiography. Application of the 2020 criteria for cirrhotic cardiomyopathy will improve systolic and diastolic function assessment and subsequent perioperative risk stratification. The use of global strain scores is emphasized, as it provides important information beyond ejection fraction and diastolic parameters. A standardized one-parameter echo cut-off for elevated pulmonary pressures simplifies both evaluation and follow-up. Innovative transcutaneous techniques for valvular stenosis and regurgitation offer new options for patients at prohibitive surgical risk.

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“…Computed tomography (CT) coronary artery calcium (CAC) score also correlated with perioperative risk, and CAC scoring was found to be a successful rule-out test prior to liver transplantation, with the authors concluding patients with a CAC <100 can safely undergo transplantation without further stress testing; however this was a highly pre-selected group and it is notable that participants had a low event rate, with only three MINS events occuring. 29 Whilst CAC scoring is not discussed in the recent ESC guidelines (2022), it’s predictive or rule-out value in this setting is of particular interest, given the proportion of patients due to undergo NCS who will undergo preoperative CT imaging, and in whom this additional information could be provided without any additional investigations or cost. 30 A recent study validated this approach, using a simple CAC severity scoring method on non-gated CT chest imaging conducted within 12 months of NCS; they found increasing incidence of 30 day mortality or MI as the score increased.…”

Section: Preoperative Risk Assessmentmentioning

confidence: 99%

Assessment and Management of Ischaemic Heart Disease in Non-Cardiac Surgery

Morgan,

Ezad,

Rahman

et al. 2023

Heart International

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In the setting of non-cardiac surgery, cardiac complications contribute to over a third of perioperative deaths. With over 230 million major surgeries performed annually, and an increasing prevalence of cardiovascular risk factors and ischaemic heart disease, the incidence of perioperative myocardial infarction is also rising. The recent European Society of Cardiology guidelines on cardiovascular risk in non-cardiac surgery elevated practices aiming to identify those at most risk, including biomarker monitoring and stress testing. However the current evidence base on if, and how, the risk of cardiac events can be modified is lacking. This review focuses on patient, surgical and cardiac risk assessment, as well as exploring the data on perioperative revascularization and other risk-reduction strategies.

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Use of Computed Tomography Coronary Calcium Score for Coronary Artery Disease Risk Stratification During Liver Transplant Evaluation

Cited by 9 publications

References 44 publications

CACS, CCTA and mCAD‐LT score in the pre‐transplant assessment of coronary artery disease and the prediction of post‐transplant cardiovascular events

CACS, CCTA and mCAD‐LT score in the pre‐transplant assessment of coronary artery disease and the prediction of post‐transplant cardiovascular events

Cardiac evaluation of the liver transplant candidate

Assessment and Management of Ischaemic Heart Disease in Non-Cardiac Surgery

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