title: The role of coronary calcium score in the risk assessment of liver transplant candidates.
abstract: BACKGROUND
  Coronary artery disease (CAD) is a common cause of morbidity and mortality in liver transplant (LT) recipients. To date there is no consensus on the preferred screening tests to detect CAD in the pre-LT population. Therefore the aim of this study was to: 1) evaluate the utility of a noninvasive tool (cardiac computerized tomography [CT] scan); and 2) determine the prevalence of CAD in low-risk LT candidates.
  
  
  METHODS
  Using our transplant database we identified all LT candidates classified as low risk for CAD. All low-risk candidates underwent cardiac CT scan for coronary calcium score (CCS) estimation. Those with CCS >100 underwent coronary angiogram, and those with <100 underwent stress test and if stress test was positive then coronary angiography was performed. The Agatston calcium score was classified as: normal (0), mild (1-100), moderate (101-400), severe (401-1,000), or extensive (>1,000).
  
  
  RESULTS
  Eighty-five LT candidates were classified as low risk and underwent cardiac CT scan. The mean calcium score was 325 (range, 0-3,707). In our study cohort, 21% had normal CCS score, 43% mild, 13% moderate, 11% severe, and 12% extensive. A calcium score >400 was significantly associated with CAD on angiography (P = .02). Although male sex was significantly associated with the presence of CAD (P = .006), there was no correlation with age, ethnicity, liver diagnosis, or Model for End-Stage Liver Disease score.
  
  
  CONCLUSIONS
  Prevalence of asymptomatic CAD in this low-risk population is relatively high. Cardiac CT is well tolerated and is a useful noninvasive screening tool in LT candidates. Future studies to determine its utility as a prognostic tool after LT will be invaluable.
authors: Tampa General Medical Group, Tampa, Florida. Electronic address: nkemmer947@aol.com.
authors: N
authors: N
authors: Kemmer
authors: University of Cincinnati, Cincinnati, Ohio.
authors: J
authors: J
authors: Case
authors: University of Cincinnati, Cincinnati, Ohio.
authors: S
authors: S
authors: Chandna
authors: Tampa General Medical Group, Tampa, Florida.
authors: G W
authors: GW
authors: Neff
mesh_terms: D000328:Adult; D000368:Aged; D002118:Calcium / Q000378:metabolism*; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D017093:Liver Failure / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D002118:Calcium