title: Accuracy of stress myocardial perfusion imaging to diagnose coronary artery disease in end stage liver disease patients.
abstract: Patients with end-stage liver disease (ESLD) who also have underlying coronary artery disease (CAD) may be at increased risk for undergoing hemodynamically challenging orthotopic liver transplantation. Noninvasive single-photon emission computed tomographic (SPECT) imaging is often used to determine whether a patient with ESLD has unsuspected CAD. The objective of this study was to determine the accuracy of SPECT imaging for detection of CAD in patients with ESLD. Patients with ESLD who underwent coronary angiography and SPECT imaging before orthotopic liver transplantation were analyzed retrospectively. The predictive accuracy of clinical risk factors was calculated and compared to the results of SPECT imaging. There were 473 SPECT imaging studies. Adenosine SPECT imaging had a sensitivity of 62%, specificity of 82%, positive predictive value of 30%, and negative predictive value of 95% for diagnosing severe CAD. Regadenoson SPECT imaging had a sensitivity of 35%, specificity of 88%, positive predictive value of 23%, and negative predictive value of 93% for diagnosing severe CAD. The accuracy of a standard risk factor analysis showed no statistical difference in predicting CAD compared with adenosine (sensitivity McNemar's p = 0.48, specificity McNemar's p = 1.00) or regadenoson (sensitivity McNemar's p = 0.77, specificity McNemar's p = 1.00) SPECT studies. In conclusion, the 2 pharmaceutical agents had low sensitivity but high specificity for diagnosing CAD. However, because the sensitivity of the test is low, the chances of missing patients with ESLD with CAD is high, making SPECT imaging an inaccurate screening test. A standard risk factor analysis as a predictor for CAD in patients with ESLD is less expensive, has no radiation exposure, and is as accurate as SPECT imaging.
authors: Division of Cardiology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA.
authors: Suchit
authors: S
authors: Bhutani
authors: Jonathan
authors: J
authors: Tobis
authors: Rubine
authors: R
authors: Gevorgyan
authors: Arjun
authors: A
authors: Sinha
authors: William
authors: W
authors: Suh
authors: Henry M
authors: HM
authors: Honda
authors: Gabriel
authors: G
authors: Vorobiof
authors: René R S
authors: RR
authors: Packard
authors: Randolph
authors: R
authors: Steadman
authors: Christopher
authors: C
authors: Wray
authors: Ronald
authors: R
authors: Busuttil
authors: Chi-hong
authors: CH
authors: Tseng
mesh_terms: D016009:Chi-Square Distribution; D015897:Comorbidity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D058625:End Stage Liver Disease / Q000150:complications* / Q000601:surgery; D005260:Female; D006339:Heart Rate; D006801:Humans; D016014:Linear Models; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon