Health
Risk of vascular and valve calcification and CAD before liver transplantation
The addition of abdominal vascular, coronary, and valve calcification status data to echocardiographic data improves the identification of obstructive coronary artery disease (CAD) in patients with cirrhosis. American Journal of Cardiology.
Patients with cirrhosis who were evaluated for orthotopic liver transplantation at Indiana University between 2000 and 2020 were eligible for this single-center, retrospective, case-control study. A random sample of 88 patients with obstructive CAD and 97 patients without obstructive CAD were included in the study. Identification of CAD was assessed by adding independent variables using a nested logistic regression model. A model was determined that best discriminated between patients with and without CAD.
CAD patients were older (P. =.003), with more males (P. =.001), more insulin (P. =.007) than patients without CAD. Among the CAD group, 64.8% had obstructive CAD.
Abnormal stress echocardiograms were defined as those with chest pain, ischemia, wall motion abnormalities, stress-induced left ventricular hypopotentiation, mitral valve calcification, and/or aortic valve calcification. Echocardiographic abnormalities occurred in 72.7% of patients with CAD and 46.4% of patients without CAD (P. =.003). Abnormal stress echocardiography showed an area under the curve (AUC) of 0.58, a sensitivity of 35.2%, a specificity of 81.4%, a positive predictive value (PPV) of 63.3, and a negative predictive value (NPV) for detecting obstructive CAD. ) was 58.1.
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Prospective studies evaluating the effects of vascular and valvular calcification and stress testing on the ability to identify obstructive CAD in patients with cirrhosis prior to liver transplantation are needed.
Abdominal calcification was observed in 50% of patients with CAD and 36.1% of patients without CAD (P. =.06) and coronary artery calcification between 28.4% and 22.7% (P. =.008), respectively.
By adding aortic valve stiffness or stenosis data to abnormal stress echocardiographic data, the AUC for detecting obstructive CAD increased to 0.69. Adding mitral calcification data to aortic sclerosis or stenosis data and abnormal stress echocardiography data resulted in an AUC of 0.69. For each progressive model, add data for abdominal calcification (AUC, 0.72), computed tomography coronary artery calcium (AUC, 0.73), age, sex, and diabetes requiring insulin status (AUC, 0.80). improved the predictive power of the model.
The final model with all predictors was significantly more predictive than abnormal stress alone (P. <.001) with a sensitivity of 58.0%, a specificity of 88.7%, a PPV of 82.3 and an NPV of 69.9. CAD.
Limitations of this study include a retrospective, single-center design.
These data indicate that adding vascular calcification data to stress echo may improve CAD discrimination in patients with cirrhosis. “Our study should be viewed as exploratory and hypothetical,” wrote the study authors. There is a need for prospective studies assessing the effects of transformation and stress testing.”
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