Microvascular autonomic dysfunction may justify false-positive stress myocardial perfusion imaging in patients with liver cirrhosis undergoing liver transplantation.
BACKGROUND
Up to 15% of liver transplant candidates have asymptomatic coronary artery diseases, which increase the risk of cardiac complications during and after transplantation. The aim of this study was to prospectively investigate the usefulness of an integrated cardiological approach in cirrhotic patients undergoing liver transplantation.


METHODS
Twenty-four consecutive patients undergoing evaluation for liver transplantation were studied by assessing risk factors for coronary artery diseases, electrocardiogram with QTc interval determination, chest X-ray, echocardiography, 24-hour Holter monitor, myocardial perfusion scintigraphy (99mTc)MIBI-GSPECT at rest and after dipyridamole infusion. Cardiac (123)I-metaiodobenzylguanidine (MIBG) scan and coronarography were performed in patients with myocardial perfusion defects. Twenty three of 24 patients underwent successful liver transplantation; one patient died on the waiting list.


RESULTS
Before liver transplantation, 29% of patients were diabetic and 41% were smokers. Eleven of 24 patients had a prolonged QTc interval, and 3/24 had positive myocardioscintigraphy after dipyridamole infusion: in two coronarography was negative, while the (123)I-MIBG washout was altered. No cardiac events were recorded during the short-and long-term follow-up after surgery.


CONCLUSIONS
Predictive value of positive cardiac (99mTc)MIBI-GSPECT in patients with liver cirrhosis is low, and this may be due to alterations of cardiac microvascular tone as showed by cardiac (123)I-MIBG scan.
Senzolo
M
M
Department of Surgical and Gastroenterological Sciences, University of Padua, Padua, Italy.
Bassanello
M
M
Graziotto
A
A
Zucchetta
P
P
Cillo
U
U
Maraglino
G
G
Loreno
M
M
Bellotto
F
F
Davià
G
G
Burra
P
P
D000328:Adult; D003327:Coronary Disease / Q000150:complications* / Q000209:etiology; D004562:Electrocardiography; D005189:False Positive Reactions; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery*; D016031:Liver Transplantation / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D017256:Technetium Tc 99m Sestamibi; D014463:Ultrasonography
D017256:Technetium Tc 99m Sestamibi