Coronary artery disease (CAD) is common in patients with cirrhosis who underwent orthotopic
liver transplantation (OLT) evaluation and stress echocardiogram (echo) has a low
sensitivity in these patients. This study aimed to assess the impact of vascular and
valvular calcification on the ability to identify CAD before OLT. We performed a case-control
study of 88 patients with and 97 without obstructive CAD who underwent OLT evaluation.
All patients had a preoperative stress echo, abdominal computed tomography, and cardiac
catheterization. A series of nested logistic regression models of CAD were fit by
adding independent variables of vascular (including coronary) calcification, aortic
and mitral valve calcification, age, gender, and history of diabetes mellitus requiring
insulin to a baseline model of abnormal stress echo. Compared with stress echo alone,
identification of the presence or absence of vascular and valvular calcification on
routine preoperative computed tomography and echo improved the diagnostic performance
for the detection of CAD based on coronary angiogram when combined with stress echo
in patients with cirrhosis who underwent OLT evaluation (area under the curve 0.58
vs 0.73, p <0.001), which is even further improved when age, gender, and history of
diabetes mellitus requiring insulin are considered (area under the curve 0.58 vs 0.80,
p <0.001). Achieving target heart rate (p = 0.92) or rate–pressure product >25,000
(p = 0.63) did not improve the ability of stress echo to identify CAD. In conclusion,
the use of abdominal vascular, coronary artery, and valvular calcification, along
with stress echo, improves the ability to identify and rule out obstructive CAD before
OLT compared with stress echo alone.
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Article info
Publication history
Published online: January 07, 2023
Received in revised form:
November 29,
2022
Received:
June 24,
2022
Footnotes
Funding: none.
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