Carey W D, Dumot J A, Pimentel R R, Barnes D S, Hobbs R E, Henderson J M, Vogt D P, Mayes J T, Westveer M K, Easley K A
Department of Gastroenterology, Cleveland Clinic Foundation, Ohio 44195, USA.
Transplantation. 1995 Mar 27;59(6):859-64.
The prevalence of angiographically proven coronary artery disease (CAD) in adults with end-stage liver disease who undergo evaluation for liver transplantation is unknown; also it is unclear if cholestatic liver disease represents an independent risk factor. Patients with end-stage liver disease over age 50 having liver transplantation were studied using coronary angiography. Arterial stenosis was graded as normal, mild (< 30%), moderate (30 to 70%), or severe (> 70%). Risk factors for CAD were also assessed (male sex, smoking, hypertension, diabetes, family history of premature heart disease). Complications related to the angiography and decision making based on the findings were recorded. Thirty seven patients (23 females) with a median age of 61 years (range 50 to 71) underwent angiography. Thirteen patients (35.1%) had cholestatic liver disease. Thirty patients had no history of heart disease. The overall prevalence of severe coronary artery disease was 16.2% (95% confidence interval [CI] = 6.2% to 32.0%). No association was detected between CAD and cholestatic liver disease (P = 0.72). After eliminating seven patients with a prior history of angina (n = 1), myocardial infarction (n = 1), or coronary revascularization (n = 5), the frequency of moderate or severe CAD was 13.3% (95% CI = 3.8% to 30.7%). No association was detected between unsuspected CAD and cholestatic liver disease (P = 0.61). Diabetes was the most important risk factor for moderate or severe disease (P = 0.01). Patients without risk factors had significantly less CAD than the group as a whole regardless of the liver disease type (P = 0.02). Two patients experienced transient renal insufficiency after the angiography. Three patients with severe CAD were denied transplantation. We conclude that CAD represents a significant problem in patients over age 50 undergoing liver transplant evaluation. Cholestatic liver disease was not associated with a significantly higher prevalence of moderate or severe CAD in our population. Diabetes was the most predictive risk factor, and those without risk factors do not require extensive preoperative cardiac evaluation.
接受肝移植评估的终末期肝病成年患者中，经血管造影证实的冠状动脉疾病（CAD）的患病率尚不清楚；胆汁淤积性肝病是否为独立危险因素也不明确。对50岁以上接受肝移植的终末期肝病患者进行冠状动脉造影研究。动脉狭窄程度分为正常、轻度（<30%）、中度（30%至70%）或重度（>70%）。还评估了CAD的危险因素（男性、吸烟、高血压、糖尿病、早发性心脏病家族史）。记录与血管造影相关的并发症以及基于检查结果所做的决策。37例患者（23例女性）接受了血管造影，中位年龄61岁（范围50至71岁）。13例患者（35.1%）患有胆汁淤积性肝病。30例患者无心脏病史。重度冠状动脉疾病的总体患病率为16.2%（95%置信区间[CI]=6.2%至32.0%）。未发现CAD与胆汁淤积性肝病之间存在关联（P=0.72）。排除7例有既往心绞痛病史（n=1）、心肌梗死病史（n=1）或冠状动脉血运重建病史（n=5）的患者后，中度或重度CAD的发生率为13.3%（CI=3.8%至30.7%）。未发现隐匿性CAD与胆汁淤积性肝病之间存在关联（P=0.61）。糖尿病是中度或重度疾病的最重要危险因素（P=0.01）。无论肝病类型如何，无危险因素的患者CAD发生率显著低于总体人群（P=0.02）。2例患者血管造影后出现短暂性肾功能不全。3例重度CAD患者被拒绝移植。我们得出结论，CAD是50岁以上接受肝移植评估患者的一个重要问题。在我们的研究人群中，胆汁淤积性肝病与中度或重度CAD的患病率显著升高无关。糖尿病是最具预测性的危险因素，无危险因素的患者无需进行广泛的术前心脏评估。
