Cardiovascular Division, Department of Medicine, University of Minnesota Medical School.
Department of Medicine, University of Minnesota Medical School.
Am J Cardiol. 2024 Nov 1;230:14-21. doi: 10.1016/j.amjcard.2024.08.021. Epub 2024 Aug 27.
Cardiac complications are the leading cause of morbidity and mortality in recipients of liver transplant (LT). Previous guidelines recommended stress testing to exclude coronary artery disease (CAD), although recent guidelines recommend coronary computed tomography angiography (CCTA). We aimed to assess the prevalence and predictors of CAD on CCTA and compare CCTA with stress testing in consecutive adult candidates for LT who underwent CAD noninvasive assessment between 2020 and 2023. Patients who underwent a stress test between January and December 2020 formed the stress cohort, and patients who underwent CCTA between January 2021 and September 2023 formed the CCTA cohort. There were 141 patients in the stress test cohort and 269 patients in the CCTA cohort. Stress test results were nondiagnostic or inconclusive in 18 patients (12.8%) whereas CCTA was nondiagnostic in 6 patients (2.2%). In patients evaluated with CCTA, mean coronary artery calcium (CAC) score was 332 ± 716 AU, with moderate or greater (>50%) stenosis in 33 patients (12.3%). New CAD was diagnosed in 158 patients (58.7%) using CCTA and in 5 patients (3.5%) using stress tests. Clinically actionable CAD (coronary artery calcium >100) on CCTA was present in 96 patients (35.7%). The number of CAD risk factors was associated with the presence of CAD on CCTA. In conclusion, there was a great burden of CAD, mainly nonobstructive, in a large cohort of candidates for LT who underwent CAD testing over a 4-year period. The current recommended risk-based evaluation of candidates for LT using CCTA as a first-line test was feasible and effective. Diagnosis of clinically actionable CAD on CCTA provides a vast opportunity for optimizing cardiac care in candidates for and recipients of LT.
心脏并发症是肝移植 (LT) 受者发病率和死亡率的主要原因。以前的指南建议进行应激测试以排除冠状动脉疾病 (CAD)，尽管最近的指南建议进行冠状动脉计算机断层扫描血管造影 (CCTA)。我们旨在评估连续成年 LT 候选者中 CAD 在 CCTA 上的患病率和预测因素，并比较 CCTA 与 2020 年至 2023 年间进行的 CAD 非侵入性评估的应激测试。在 2020 年 1 月至 12 月期间接受应激测试的患者形成应激测试队列，而在 2021 年 1 月至 2023 年 9 月期间接受 CCTA 的患者形成 CCTA 队列。应激测试队列中有 141 名患者，CCTA 队列中有 269 名患者。在 18 名患者（12.8%）中，应激测试结果不可诊断或不确定，而在 6 名患者（2.2%）中，CCTA 结果不可诊断。在接受 CCTA 评估的患者中，平均冠状动脉钙（CAC）评分 332±716 AU，33 名患者（12.3%）存在中度或更严重 (>50%)狭窄。在 158 名患者（58.7%）中使用 CCTA 诊断出新发 CAD，在 5 名患者（3.5%）中使用应激测试诊断出 CAD。在 CCTA 上存在有临床意义的 CAD（冠状动脉钙 >100）的患者为 96 名（35.7%）。CAD 的危险因素数量与 CCTA 上 CAD 的存在有关。总之，在过去 4 年期间，对接受 CAD 检测的 LT 候选者进行了一项大型队列研究，发现了大量的 CAD 负担，主要是非阻塞性的。使用 CCTA 作为一线测试对 LT 候选者进行基于风险的评估是可行且有效的。在 CCTA 上诊断出有临床意义的 CAD 为 LT 候选者和接受者的心脏护理优化提供了巨大的机会。
