BACKGROUND: The significant potential for perioperative and late cardiovascular complications makes careful preoperative cardiac risk assessment imperative in liver transplantation candidates. OBJECTIVE: To determine the sensitivity and specificity of myocardial perfusion scanning for detection of coronary artery disease (CAD) in liver transplantation candidates. PATIENTS AND METHODS: We prospectively evaluated 93 liver transplantation candidates. Patients with known CAD were excluded. All patients, regardless of symptoms and risk factors, underwent myocardial perfusion scanning and coronary angiography. RESULTS: Results of myocardial perfusion scanning were abnormal in 64 patients (68.8%) and normal in 29 patients (31.2%). Of patients with abnormal scans, only 6 (9.4%) had severe CAD at coronary angiography. None of the 29 patients with normal perfusion scans and the 24 patients with fixed defects had severe CAD; however, 6 of 40 patients (15.0%) with reversible perfusion defects had severe CAD at coronary angiography (P = .005). Alcoholic liver disease, reversible perfusion defects at myocardial perfusion scanning, left ventricular systolic dysfunction, and higher low-density lipoprotein (LDL) cholesterol and triglyceride levels were significantly associated with CAD. Defining reversible perfusion defects as a sign of ischemia, and fixed defects and normal perfusion as nonischemic, myocardial perfusion scanning had 100% sensitivity but 61% specificity for severe CAD. The test's accuracy was low (38%). CONCLUSIONS: The results of reversible perfusion defects on myocardial perfusion scanning were sensitive but not specific for CAD in liver transplantation candidates. The high number of false-positive results decreased the test's accuracy.
BACKGROUND: The significant potential for perioperative and late cardiovascular complications makes careful preoperative cardiac risk assessment imperative in liver transplantation candidates. OBJECTIVE: To determine the sensitivity and specificity of myocardial perfusion scanning for detection of coronary artery disease (CAD) in liver transplantation candidates. PATIENTS AND METHODS: We prospectively evaluated 93 liver transplantation candidates. Patients with known CAD were excluded. All patients, regardless of symptoms and risk factors, underwent myocardial perfusion scanning and coronary angiography. RESULTS: Results of myocardial perfusion scanning were abnormal in 64 patients (68.8%) and normal in 29 patients (31.2%). Of patients with abnormal scans, only 6 (9.4%) had severe CAD at coronary angiography. None of the 29 patients with normal perfusion scans and the 24 patients with fixed defects had severe CAD; however, 6 of 40 patients (15.0%) with reversible perfusion defects had severe CAD at coronary angiography (P = .005). Alcoholic liver disease, reversible perfusion defects at myocardial perfusion scanning, left ventricular systolic dysfunction, and higher low-density lipoprotein (LDL) cholesterol and triglyceride levels were significantly associated with CAD. Defining reversible perfusion defects as a sign of ischemia, and fixed defects and normal perfusion as nonischemic, myocardial perfusion scanning had 100% sensitivity but 61% specificity for severe CAD. The test's accuracy was low (38%). CONCLUSIONS: The results of reversible perfusion defects on myocardial perfusion scanning were sensitive but not specific for CAD in liver transplantation candidates. The high number of false-positive results decreased the test's accuracy.
Authors: E Gordon Depuey; John J Mahmarian; Todd D Miller; Andrew J Einstein; Christopher L Hansen; Thomas A Holly; Edward J Miller; Donna M Polk; L Samuel Wann Journal: J Nucl Cardiol Date: 2012-04 Impact factor: 5.952
Authors: Sanjaya K Satapathy; Jason M Vanatta; Ryan A Helmick; Albert Flowers; Satish K Kedia; Yu Jiang; Bilal Ali; James Eason; Satheesh P Nair; Uzoma N Ibebuogu Journal: Transplantation Date: 2017-04 Impact factor: 4.939
Authors: Robert J Donovan; Calvin Choi; Asghar Ali; Douglas M Heuman; Michael Fuchs; Anthony A Bavry; Ion S Jovin Journal: Dig Dis Sci Date: 2016-11-09 Impact factor: 3.199
Authors: Lisa B VanWagner; Matthew E Harinstein; James R Runo; Christopher Darling; Marina Serper; Shelley Hall; Jon A Kobashigawa; Laura L Hammel Journal: Am J Transplant Date: 2017-11-18 Impact factor: 8.086