Myocardial perfusion imaging is an effective screening test for coronary artery disease in liver transplant candidates

Sally Baker, Charles Chambers, Patrick Mcquillan, Piotr Janicki, Zakiyah Kadry, Daniel Bowen, Dmitri Bezinover

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

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).

Original languageEnglish (US)
Pages (from-to)319-326
Number of pages8
JournalClinical Transplantation
Volume29
Issue number4
DOIs
StatePublished - Apr 1 2015

All Science Journal Classification (ASJC) codes

  • Transplantation

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