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Am J Cardiol. 2019 Jul 15;124(2):278-284. doi: 10.1016/j.amjcard.2019.04.025. Epub 2019 Apr 23.

Significance of Coronary Artery Calcium Found on Non-Electrocardiogram-Gated Computed Tomography During Preoperative Evaluation for Liver Transplant.

Author information

1
Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. Electronic address: bwest@mednet.ucla.edu.
2
Department of Medical Education, California Northstate University, Elk Grove, California.
3
Department of Radiology, UC Irvine Medical Center, Orange, California.
4
Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
5
Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
6
Division of Cardiology, Los Angeles Biomedical Research Institute, Harbor-UCLA, Torrance, California.
7
Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Biostatistics, UCLA, Los Angeles, California; Department of Biomathematics, UCLA, Los Angeles, California.
8
Division of Cardiology, Department of Medicine, Section of Interventional Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California.

Abstract

Guidelines to evaluate patients for coronary artery disease (CAD) during preoperative evaluation for orthotopic liver transplantation (OLT) are conflicting. Cardiac catheterization is not without risk in patients with end-stage liver disease. No study to date has looked at the utility of non-electrocardiogram-gated chest computed tomography (CT) in the preliver transplant population. Our hypothesis was that coronary artery calcium scores (CACSs) from chest CT scans ordered during the liver transplant workup can identify patients who would benefit from invasive angiography. Nine hundred and fifty-three patients who underwent coronary angiography as part of their OLT workup were considered. Charts were randomly selected and reviewed for the presence of a chest CT performed before coronary angiography during the OLT workup. Agatston and Weston scores were calculated. CACS results were compared with coronary angiography findings. Nine of 54 patients were found to have obstructive CAD by angiography. Receiver-operating characteristic analysis demonstrated that an Agatston score of 251 and a Weston score of 6 maximized sensitivity and specificity for detection of obstructive coronary disease. An Agatston score <4 or Weston score <2 excluded the presence of obstructive CAD; using these thresholds, 13 patients (24%) or 15 patients (28%), respectively, could have theoretically avoided catheterization without missing significant CAD. In conclusion, our data identify the strength of CACS in ruling out coronary disease in patients being evaluated for OLT. Calcium scoring from non-electrocardiogram-gated CT studies may be integrated into preoperative algorithms to rule out obstructive CAD and help avoid invasive angiography in this high-risk population.

PMID:
31122618
PMCID:
PMC6581589
[Available on 2020-07-15]
DOI:
10.1016/j.amjcard.2019.04.025
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