Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Division of Cardiology, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA.
J Hepatol. 2021 Jul;75(1):142-149. doi: 10.1016/j.jhep.2021.01.008. Epub 2021 Jan 18.
BACKGROUND & AIMS: Patients with cirrhosis and significant coronary artery disease (CAD) are at risk of peri-liver transplantation (LT) cardiac events. The coronary artery disease in liver transplantation (CAD-LT) score and algorithm aim to predict the risk of significant CAD in LT candidates and guide pre-LT cardiac evaluation.
Patients who underwent pre-LT evaluation at Indiana University (2010-2019) were studied retrospectively. Stress echocardiography (SE) and cardiac catheterization (CATH) reports were reviewed. CATH was performed for predefined CAD risk factors, irrespective of normal SE. Significant CAD was defined as CAD requiring percutaneous or surgical intervention. A multivariate regression model was constructed to assess risk factors. Receiver-operating curve analysis was used to compute a point-based risk score and a stratified testing algorithm.
A total of 1,771 pre-LT patients underwent cardiac evaluation, including results from 1,634 SE and 1,266 CATH assessments. Risk-adjusted predictors of significant CAD at CATH were older age (adjusted odds ratio 1.05; 95% CI 1.03-1.08), male sex (1.69; 1.16-2.50), diabetes (1.57; 1.12-2.22), hypertension (1.61; 1.14-2.28), tobacco use (pack years) (1.01; 1.00-1.02), family history of CAD (1.63; 1.16-2.28), and personal history of CAD (6.55; 4.33-9.90). The CAD-LT score stratified significant CAD risk as low (≤2%), intermediate (3% to 9%), and high (≥10%). Among patients who underwent CATH, a risk-based testing algorithm (low: no testing; intermediate: non-invasive testing vs. CATH; high: CATH) would have identified 97% of all significant CAD and potentially avoided unnecessary testing (669 SE [57%] and 561 CATH [44%]).
The CAD-LT score and algorithm (available at www.cad-lt.com) effectively stratify pre-LT risk for significant CAD. This may guide more targeted testing of candidates with fewer tests and faster time to waitlist.
The coronary artery disease in liver transplantation (CAD-LT) score and algorithm effectively stratify patients based on their risk of significant coronary artery disease. The CAD-LT algorithm can be used to guide a more targeted cardiac evaluation prior to liver transplantation.
患有肝硬化和严重冠状动脉疾病（CAD）的患者在肝移植（LT）期间有发生心脏事件的风险。CAD-LT 评分和算法旨在预测 LT 候选者中严重 CAD 的风险，并指导 LT 前的心脏评估。
回顾性研究了在印第安纳大学进行 LT 前评估的患者（2010-2019 年）。审查了应激超声心动图（SE）和心导管检查（CATH）报告。CATH 是为了明确 CAD 的既定危险因素而进行的，无论 SE 是否正常。显著 CAD 定义为需要经皮或手术干预的 CAD。构建多变量回归模型以评估风险因素。使用接收者操作曲线分析计算基于点的风险评分和分层测试算法。
共有 1771 例 LT 前患者接受了心脏评估，其中包括 1634 例 SE 和 1266 例 CATH 评估的结果。CATH 检查中显著 CAD 的风险调整预测因素为年龄较大（调整后的优势比 1.05；95%可信区间 1.03-1.08）、男性（1.69；1.16-2.50）、糖尿病（1.57；1.12-2.22）、高血压（1.61；1.14-2.28）、吸烟（包年）（1.01；1.00-1.02）、CAD 家族史（1.63；1.16-2.28）和个人 CAD 病史（6.55；4.33-9.90）。CAD-LT 评分将显著 CAD 风险分层为低（≤2%）、中（3%至 9%）和高（≥10%）。在接受 CATH 的患者中，基于风险的测试算法（低：无需测试；中：非侵入性测试与 CATH；高：CATH）将确定所有显著 CAD 的 97%，并可能避免不必要的测试（669 例 SE [57%]和 561 例 CATH [44%]）。
CAD-LT 评分和算法（可在 www.cad-lt.com 获得）可有效分层 LT 前严重 CAD 的风险。这可能有助于对具有更少测试和更快等待名单时间的候选者进行更有针对性的测试。
CAD-LT 评分和算法可有效根据患者发生严重冠状动脉疾病的风险对患者进行分层。CAD-LT 算法可用于指导肝移植前更有针对性的心脏评估。
