title: Clinical value of preoperative coronary risk assessment by computed tomographic arteriography prior to adult living donor liver transplantation.
abstract: OBJECTIVE
  Patients with advanced liver diseases are at increased risk of cardiovascular events, resulting in a higher incidence of cardiac complications following liver transplantation (OLT). We assessed the clinical value of computed tomographic coronary arteriography (CTCAG) as a routine preoperative cardiac evaluation test in adult patients scheduled for living donor OLT (LDLT).
  
  
  METHODS
  This single-center, prospective, observational study evaluated 247 adult patients being assessed for LDLT from April 2010 to March 2011. CTCAG was performed in patients with all-negative findings on routine cardiac workup, including thallium single photon emission computed tomography (SPECT).
  
  
  RESULTS
  Of the 247 patients evaluated, 27 (10.9%) showed abnormal findings on CTCAG, with 18 (7.3%) showing mild to moderate involvement of one vessel; 7 (2.8%), two-vessel; and 2 (0.8%), three-vessel involvement. Coronary artery calcification was identified in patients with significant coronary artery stenosis. No adverse events occurred after CTCAG. Noticeable hypotensive episodes during LDLT surgery occurred in 5% of patients, mostly related to massive bleeding or postperfusion syndrome. During the first 3 months after LDLT, 3% of patients showed stress cardiomyopathy, but all recovered with supportive care.
  
  
  CONCLUSIONS
  The poor general medical condition of LDLT candidates and the diagnostic accuracy of CTCAG suggest that this test should be included in the routine pretransplant cardiac workup, along with thallium SPECT, for these patients.
authors.affiliation: Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: W-Y
authors.initials: WY
authors.lastname: Chae
authors.forename: S
authors.initials: S
authors.lastname: Hwang
authors.forename: Y-I
authors.initials: YI
authors.lastname: Yoon
authors.forename: M-C
authors.initials: MC
authors.lastname: Kang
authors.forename: D-B
authors.initials: DB
authors.lastname: Moon
authors.forename: G-W
authors.initials: GW
authors.lastname: Song
authors.forename: G-C
authors.initials: GC
authors.lastname: Park
authors.forename: D-H
authors.initials: DH
authors.lastname: Jung
authors.forename: J-M
authors.initials: JM
authors.lastname: Namgoong
authors.forename: S-W
authors.initials: SW
authors.lastname: Jung
authors.forename: S-Y
authors.initials: SY
authors.lastname: Yoon
authors.forename: J-J
authors.initials: JJ
authors.lastname: Kim
authors.forename: G-S
authors.initials: GS
authors.lastname: Hwang
authors.forename: S-G
authors.initials: SG
authors.lastname: Lee
mesh_terms: D016063:Blood Loss, Surgical; D009202:Cardiomyopathies / Q000209:etiology; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology; D008107:Liver Diseases / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013794:Thallium Radioisotopes; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000150:complications / Q000000981:diagnostic imaging*
chemical_list: D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes