Lee Michael S, Wadia Subeer, Yeghiazarians Yerem, Matthews Ray, White Christopher J, Herrmann Howard C, O'Donnell William, McPherson John, Leesar Massoud A, Kreutz Rolf P, Brandman Danielle, Gupta Anuj, Mandras Stacy, Kandzari David E
Division of Cardiology, University of California, Los Angeles Medical Center, Los Angeles, California.
Division of Cardiology, University of California, San Francisco Medical Center, San Francisco, California.
J Soc Cardiovasc Angiogr Interv. 2022 Nov 25;2(1):100528. doi: 10.1016/j.jscai.2022.100528. eCollection 2023 Jan-Feb.
Orthotopic liver transplantation (OLT) is a viable treatment option for end-stage liver disease. Significant perioperative stress is placed on the cardiovascular system because of hemodynamic changes and the length of the operation. Diagnosis and treatment of cardiovascular disease before OLT are imperative to ensure favorable outcomes. Considerable variability exists among practitioners caring for these patients. Institutions tailor their protocols on the basis of local and historical practices, the preferences of the cardiologists, and the OLT team, and algorithms are not often revised or updated on the basis of the available evidence. In collaboration with cardiology and hepatology experts from leading OLT centers, we sought to examine the diagnostic cardiovascular workup of OLT candidates, including a review of the available literature on the diagnostic modalities used to screen cardiovascular disease before OLT. We advocate an emphasis on noninvasive methods to assess cardiovascular risk with reserved use of invasive risk stratification in select patients.
原位肝移植（OLT）是终末期肝病的一种可行治疗选择。由于血流动力学变化和手术时间长，围手术期心血管系统承受着巨大压力。OLT术前对心血管疾病进行诊断和治疗对于确保良好预后至关重要。在照顾这些患者的从业者中存在相当大的差异。各机构根据当地和既往的做法、心脏病专家和OLT团队的偏好来制定其方案，而且算法并不经常根据现有证据进行修订或更新。我们与领先的OLT中心的心脏病学和肝病学专家合作，试图研究OLT候选者的心血管诊断检查，包括回顾关于OLT术前用于筛查心血管疾病的诊断方式的现有文献。我们主张重点采用非侵入性方法评估心血管风险，对部分患者谨慎使用侵入性风险分层。
