Prevalence of coronary artery calcification in patients undergoing assessment for orthotopic liver transplantation

Abstract

Patients with advanced liver disease are at increased risk of cardiovascular events, especially following orthotopic liver transplantation (OLT). Coronary artery calcification (CAC) is a novel and independent predictor of cardiovascular risk, but its prevalence and utility in patients with cirrhosis are unknown. The aim of this study was to define the prevalence of CAC and its association with markers of disease severity and standard measures of cardiovascular risk in a large cohort of patients undergoing OLT assessment. A single-center, prospective, observational study of 147 consecutive patients undergoing assessment for OLT was performed. CAC scores were derived with the Agatston method from thoracic computed tomography scans and correlated with cardiovascular risk factors and measures of liver disease severity. There were 101 patients (66 males) with a mean age of 53.2 years; 46 patients were excluded because the CAC score was not reported. The median CAC score was 40 HU (range, 0-3533). Correlations were identified between the CAC score and age (r ϭ 0.477; P Ͻ 0.001), male sex (r ϭ 0.262; P ϭ 0.008), family history of cardiovascular disease (r ϭ 0.208; P ϭ 0.036), Framingham risk score (r ϭ 0.621; P Ͻ 0.001), Model for End-Stage Liver Disease score (r ϭ 0.221; P ϭ 0.027), systolic blood pressure (r ϭ 0.285; P ϭ 0.004), diastolic blood pressure (r ϭ 0.267; P ϭ 0.007), cytomegalovirus status (r ϭ 0.278; P ϭ 0.005), fasting glucose (r ϭ 0.330; P ϭ 0.001), number of coronary vessels involved (r ϭ 0.899; P Ͻ 0.001), and components of the metabolic syndrome (r ϭ 0.226; P ϭ 0.026). After multivariate analysis, age, systolic blood pressure, fasting glucose, number of features of metabolic syndrome, and number of vessels involved remained significantly associated with CAC. In conclusion, this study identified a high prevalence of occult coronary artery disease in patients undergoing OLT assessment and identified a strong relationship between CAC scores and a limited number of specific cardiovascular risk factors. The usefulness of these factors in predicting perioperative and postoperative cardiovascular events in patients undergoing OLT requires prospective evaluation. Liver

The heart in liver transplantation

“…A recent study [101] of 101 cirrhotic patients showed a strong relationship between the CACS and a number of specific cardiovascular risk factors. In this study, the CACS revealed a high prevalence of occult coronary artery disease in patients undergoing LT assessment.…”

Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates

“…DSE was positive in 7.5% of patients and had a high sensitivity and specificity for CAD in this cohort, but the number of patients studied was small. A study of coronary artery calcium scores in 101 liver transplantation candidates found an elevated coronary artery calcium score in 74% of asymptomatic patients, 288 with 37.6% having scores in the moderate-risk range (Ͼ100, or Ϸ2% predicted annual risk of cardiac events) and 19.8% having scores in the high-risk range (Ͼ400, or Ϸ3% to 5% predicted annual risk of cardiac events). 289 There is considerable concern about the efficacy and cost-effectiveness of the screening strategy used for CAD identification before liver transplantation.…”

Cardiovascular Risk Assessment of the Liver Transplant Candidate

“…Whether nonalcoholic steatohepatitis cirrhosis is an independent CAD risk factor with incremental predictive value over these traditional risk factors remains to be determined (26 -28). Coronary calcium is also strongly associated with traditional CAD risk factors in the cirrhotic population (29). In addition, concomitant renal dysfunction in the setting of ESLD is associated with increased cardiovascular risk (30).…”