Cardiovascular Evaluation of Liver Transplant Patients by Using Coronary Calcium Scoring in ECG-Synchronized Computed Tomographic Scans

Abstract

Background: The goal of cardiac evaluation of patients awaiting orthotopic liver transplantation (OLT) is to identify the patients at risk for cardiovascular events (CVEs) in the peri- and postoperative periods by opportunistic evaluation of coronary artery calcium (CAC) in non-gated abdominal computed tomographs (CT). Methods: We hypothesized that in patients with OLT, a combination of Lee’s revised cardiac index (RCRI) and CAC scoring would improve diagnostic accuracy and prognostic impact compared to non-invasive cardiac testing. Therefore, we retrospectively evaluated 169 patients and compared prediction of CVEs by both methods. Results: Standard workup identified 22 patients with a high risk for CVEs during the transplant period, leading to coronary interventions. Eighteen patients had a CVE after transplant and a CAC score > 0. The combination of CAC and RCRI ≥ 2 had better negative (NPV) and positive predictive values (PPV) for CVEs (NPV 95.7%, PPV 81.6%) than standard non-invasive stress tests (NPV 92.0%, PPV 54.5%). Conclusion: The cutoff value of CAC > 0 by non-gated CTs combined with RCRI ≥ 2 is highly sensitive for identifying patients at risk for CVEs in the OLT population.

Calcification of the visceral aorta and celiac trunk is associated with renal and allograft outcomes after deceased donor liver transplantation

“…CAC celiac artery calcification, VAC visceral aortic calcification analysis in patients scheduled for OLT in terms of cardiovascular outcomes [2]. In combination with Lee's revised cardiac index, the authors could demonstrate the high sensitivity of coronary artery calcification in pre-OLT CT scan in identifying patients at risk for cardiovascular events after transplantation [4].…”

“…On this account, it is of utmost clinical importance to appropriately estimate the cardiovascular risk of all patients being considered for OLT, as cardiovascular complications are a major cause of morbidity and death, not only in the perioperative time but especially during the first year post-OLT [3]. Nevertheless, there is no international consensus on the preferred pre-OLT screening to detect significant coronary artery and other vascular disease [4].…”