Tincopa Monica A, Weinberg Richard L, Sengupta Shreya, Slivnick Jeremy, Corbett James, Sonnenday Christopher J, Fontana Robert J, Sharma Pratima
Department of Internal Medicine, Division of Digestive Diseases, UCLA Health, Los Angeles, CA.
Division of Cardiovascular Medicine, Department of Surgery, University of Michigan Health System, Ann Arbor, MI.
Transplant Direct. 2022 Mar 25;8(4):e1311. doi: 10.1097/TXD.0000000000001311. eCollection 2022 Apr.
The optimal cardiovascular (CV) risk stratification in liver transplant (LT) candidates remains unclear. The aim of this study was to evaluate concordance of findings between dobutamine stress echocardiography (DSE), positron emission tomography/computed tomography myocardial perfusion imaging (PET/CT MPI), and left heart catheterization in adult LT candidates.
Data on 234 consecutive adult LT candidates from February 2015 to June 2018 with PET/CT MPI were reviewed. Adverse CV outcomes were adjudicated via chart review by a board-certified cardiologist.
Median age was 60.8, body mass index 30.2 kg/m, and model of end-stage liver disease-sodium 14; 61% were male, and 54% had diabetes. Thirty-seven percent had nonalcoholic steatohepatitis and 29% alcohol-related liver disease. Sixty-five percent of patients had a DSE, of which 41% were nondiagnostic. No factors were independently associated with having a nondiagnostic DSE. The median global myocardial flow reserve correlated positively with hemoglobin and negatively with model of end-stage liver disease-sodium, age, ejection fraction, and body mass index. Moderate/high-risk MPIs were associated with older age and known CV disease. In patients with 2 cardiac testing modalities, findings were concordant in 87%. Eleven of 53 LT recipients experienced an adverse CV outcome, but no independent predictors were identified for this outcome.
Results of different cardiac risk-stratification modalities were concordant across modalities the majority of the time in LT candidates, although these findings were not independently correlated with risk of post-LT CV outcomes. Given the high rates of nondiagnostic DSEs in this population, PET/CT MPI may be the preferred CV risk-stratification modality in older patients and those with known CV disease.
肝移植（LT）候选者的最佳心血管（CV）风险分层仍不明确。本研究的目的是评估多巴酚丁胺负荷超声心动图（DSE）、正电子发射断层扫描/计算机断层扫描心肌灌注成像（PET/CT MPI）和左心导管检查在成年LT候选者中的检查结果一致性。
回顾了2015年2月至2018年6月连续234例接受PET/CT MPI检查的成年LT候选者的数据。由一名获得委员会认证的心脏病专家通过病历审查判定不良CV结局。
中位年龄为60.8岁，体重指数为30.2kg/m²，终末期肝病-钠模型评分为14；61%为男性，54%患有糖尿病。37%患有非酒精性脂肪性肝炎，29%患有酒精性肝病。65%的患者进行了DSE检查，其中41%的检查结果无法诊断。没有因素与DSE检查结果无法诊断独立相关。中位整体心肌血流储备与血红蛋白呈正相关，与终末期肝病-钠模型、年龄、射血分数和体重指数呈负相关。中度/高风险的MPI与年龄较大和已知的CV疾病相关。在进行两种心脏检查方式的患者中，87%的检查结果一致。53例LT受者中有11例出现不良CV结局，但未发现该结局的独立预测因素。
在LT候选者中，大多数情况下不同心脏风险分层方式的结果在不同方式之间是一致的，尽管这些结果与LT后CV结局的风险没有独立相关性。鉴于该人群中DSE检查结果无法诊断的比例较高，PET/CT MPI可能是老年患者和已知CV疾病患者首选的CV风险分层方式。
