title: Myocardial perfusion imaging is an effective screening test for coronary artery disease in liver transplant candidates.
abstract: A reliable screening test for coronary artery disease (CAD) in liver transplant (LT) candidates with end-stage liver disease is essential because a high percentage of perioperative mortality and morbidity is CAD-related. In this study, the effectiveness of myocardial perfusion imaging (MPI) for identification of significant CAD in LT candidates was evaluated. Records of 244 patients meeting criteria for MPI were evaluated: 74 met inclusion criteria; 40 had a positive MPI and cardiology follow-up; 27 had a negative MPI and underwent LT; and seven had a negative MPI and then had coronary angiography or a significant cardiac event. A selective MPI interpretation strategy was established where MPI-positive patients were divided into high, intermediate, and low CAD risk groups. The overall incidence of CAD in this study population was 5.1% and our strategy resulted in PPV 20%, NPV 94%, sensitivity 80%, and specificity 50% for categorizing CAD risk. When applied only to the subset of patients categorized as high CAD risk, the strategy was more effective, with PPV 67%, NPV 97%, sensitivity 80%, and specificity 94%. We determined that renal dysfunction was an independent predictive factor for CAD (p < 0.0001, odds ratio = 8.1), and grades of coronary occlusion correlated significantly with chronic renal dysfunction (p = 0.0079).
authors.affiliation: Department of Anesthesiology, Pennsylvania State University College of Medicine, Penn State Hershey Medical Center, Hershey, PA, USA.
authors.forename: Sally
authors.initials: S
authors.lastname: Baker
authors.forename: Charles
authors.initials: C
authors.lastname: Chambers
authors.forename: Patrick
authors.initials: P
authors.lastname: McQuillan
authors.forename: Piotr
authors.initials: P
authors.lastname: Janicki
authors.forename: Zakiyah
authors.initials: Z
authors.lastname: Kadry
authors.forename: Daniel
authors.initials: D
authors.lastname: Bowen
authors.forename: Dmitri
authors.initials: D
authors.lastname: Bezinover
mesh_terms: D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000209:etiology; D058625:End Stage Liver Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology*; D006085:Graft Survival; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: coronary artery disease; dobutamine stress echo; end-stage liver disease; kidney dysfunction; myocardial perfusion imaging