학술논문
CACS, CCTA and mCAD-LT score in the pre-transplant assessment of coronary artery disease and the prediction of post-transplant cardiovascular events.
Document Type
Academic Journal
Author
Pagano G; Liver Transplant Unit, Hospital Clínic, Barcelona, Spain.; Department of Hepatology, Hospital Clínic, Barcelona, Spain.; Sastre L; Department of Gastroenterology and Hepatology, Hospital Son Espases, Palma de Mallorca, Spain.; Blasi A; Department of Anesthesiology, Hospital Clínic, Barcelona, Spain.; University of Barcelona, Barcelona, Spain.; IDIBAPS, Barcelona, Spain.; CIBER-EHD, Madrid, Spain.; Brugaletta S; University of Barcelona, Barcelona, Spain.; IDIBAPS, Barcelona, Spain.; Department of Cardiology, Hospital Clínic, Barcelona, Spain.; Mestres J; Department of Radiology, Hospital Clínic, Barcelona, Spain.; Martinez-Ocon J; Department of Anesthesiology, Hospital Clínic, Barcelona, Spain.; Ortiz-Pérez JT; University of Barcelona, Barcelona, Spain.; IDIBAPS, Barcelona, Spain.; Department of Cardiology, Hospital Clínic, Barcelona, Spain.; Viñals C; Department of Endocrinology and Nutrition, Hospital Clínic, Barcelona, Spain.; Prat-Gonzàlez S; University of Barcelona, Barcelona, Spain.; IDIBAPS, Barcelona, Spain.; Department of Cardiology, Hospital Clínic, Barcelona, Spain.; Rivas E; Department of Anesthesiology, Hospital Clínic, Barcelona, Spain.; Perea RJ; IDIBAPS, Barcelona, Spain.; Department of Radiology, Hospital Clínic, Barcelona, Spain.; Rodriguez-Tajes S; Liver Transplant Unit, Hospital Clínic, Barcelona, Spain.; Department of Hepatology, Hospital Clínic, Barcelona, Spain.; IDIBAPS, Barcelona, Spain.; CIBER-EHD, Madrid, Spain.; Muxí Á; IDIBAPS, Barcelona, Spain.; Department of Nuclear Medicine, Hospital Clínic, Barcelona, Spain.; Ortega E; University of Barcelona, Barcelona, Spain.; IDIBAPS, Barcelona, Spain.; Department of Endocrinology and Nutrition, Hospital Clínic, Barcelona, Spain.; CIBER-OBN, Madrid, Spain.; Doltra A; University of Barcelona, Barcelona, Spain.; IDIBAPS, Barcelona, Spain.; Department of Cardiology, Hospital Clínic, Barcelona, Spain.; Ruiz P; Liver Transplant Unit, Hospital Clínic, Barcelona, Spain.; Department of Hepatology, Hospital Clínic, Barcelona, Spain.; IDIBAPS, Barcelona, Spain.; Vidal B; University of Barcelona, Barcelona, Spain.; IDIBAPS, Barcelona, Spain.; Department of Cardiology, Hospital Clínic, Barcelona, Spain.; Martínez-Palli G; Department of Anesthesiology, Hospital Clínic, Barcelona, Spain.; IDIBAPS, Barcelona, Spain.; CIBER-RES, Madrid, Spain.; Colmenero J; Liver Transplant Unit, Hospital Clínic, Barcelona, Spain.; Department of Hepatology, Hospital Clínic, Barcelona, Spain.; University of Barcelona, Barcelona, Spain.; IDIBAPS, Barcelona, Spain.; CIBER-EHD, Madrid, Spain.; Crespo G; Liver Transplant Unit, Hospital Clínic, Barcelona, Spain.; Department of Hepatology, Hospital Clínic, Barcelona, Spain.; University of Barcelona, Barcelona, Spain.; IDIBAPS, Barcelona, Spain.; CIBER-EHD, Madrid, Spain.
Source
Publisher: Wiley-Blackwell Country of Publication: United States NLM ID: 101160857 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1478-3231 (Electronic) Linking ISSN: 14783223 NLM ISO Abbreviation: Liver Int Subsets: MEDLINE
Subject
Language
English
Abstract
Background: The optimal cardiovascular assessment of liver transplant (LT) candidates is unclear. We aimed to evaluate the performance of CT-based coronary tests (coronary artery calcium score [CACS] and coronary CT angiography [CCTA]) and a modification of the CAD-LT score (mCAD-LT, excluding family history of CAD) to diagnose significant coronary artery disease (CAD) before LT and predict the incidence of post-LT cardiovascular events (CVE).
Methods: We retrospectively analysed a single-centre cohort of LT candidates who underwent non-invasive tests; invasive coronary angiography (ICA) was performed depending on the results of non-invasive tests. mCAD-LT was calculated in all patients.
Results: Six-hundred-and-thirty-four LT candidates were assessed and 351 of them underwent LT. CACS, CCTA and ICA were performed in 245, 123 and 120 LT candidates, respectively. Significant CAD was found in 30% of patients undergoing ICA. The AUROCs of mCAD-LT (.722) and CCTA (.654) were significantly higher than that of CACS (.502) to predict the presence of significant CAD. Specificity of the tests ranged between 31% for CCTA and 53% for CACS. Among patients who underwent LT, CACS ≥ 400 and mCAD-LT were independently associated with the incidence of CVE; in patients who underwent CCTA before LT, significant CAD at CCTA also predicted post-LT CVE.
Conclusion: In this cohort, mCAD-LT score and CT-based tests detect the presence of significant CAD in LT candidates, although they tend to overestimate it. Both mCAD-LT score and CT-based tests classify LT recipients according to their risk of post-LT CVE and can be used to improve post-LT risk mitigation.
(© 2024 The Authors. Liver International published by John Wiley & Sons Ltd.)
Methods: We retrospectively analysed a single-centre cohort of LT candidates who underwent non-invasive tests; invasive coronary angiography (ICA) was performed depending on the results of non-invasive tests. mCAD-LT was calculated in all patients.
Results: Six-hundred-and-thirty-four LT candidates were assessed and 351 of them underwent LT. CACS, CCTA and ICA were performed in 245, 123 and 120 LT candidates, respectively. Significant CAD was found in 30% of patients undergoing ICA. The AUROCs of mCAD-LT (.722) and CCTA (.654) were significantly higher than that of CACS (.502) to predict the presence of significant CAD. Specificity of the tests ranged between 31% for CCTA and 53% for CACS. Among patients who underwent LT, CACS ≥ 400 and mCAD-LT were independently associated with the incidence of CVE; in patients who underwent CCTA before LT, significant CAD at CCTA also predicted post-LT CVE.
Conclusion: In this cohort, mCAD-LT score and CT-based tests detect the presence of significant CAD in LT candidates, although they tend to overestimate it. Both mCAD-LT score and CT-based tests classify LT recipients according to their risk of post-LT CVE and can be used to improve post-LT risk mitigation.
(© 2024 The Authors. Liver International published by John Wiley & Sons Ltd.)