*Purpose: Coronary artery disease is a leading cause of mortality following orthotopic liver transplant, yet there is not currently a standardized protocol for pre-liver-transplant coronary artery disease assessment. The primary objective of this study was to determine the agreement between two methods of cardiac risk assessment, including dobutamine stress echocardiogram (DSE) and coronary calcium score (CCS). The secondary objective of the study was to determine which of the two tests was best able to predict coronary artery disease in low-risk patients.

*Methods: A retrospective study was performed using the medical records of 436 patients who received cardiac clearance for a liver transplant. The sample size was reduced to 152 patients who received both the CCS and the DSE. A kappa coefficient was calculated to determine the agreement between the DSE and CCS results. In addition, the positive predictive value (PPV) of both CCS and DSE consistent with findings of vessel occlusion demonstrated on cardiac catheterization were analyzed to compare the accuracy of the two tests.

*Results: Our data indicated a kappa value of 12% agreement between dobutamine stress echocardiogram results and coronary calcium scores. The DSE had a PPV of 56%, and the CCS had a PPV of 80%.

*Conclusions: We confirmed no agreement between the results of the CCS and the DSE. While neither the CCS nor the DSE presents an optimal method of risk assessment, the coronary calcium score had a much higher positive predictive value and was therefore determined to be the more accurate test.

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