Session Time: 4:30pm-5:30pm
Presentation Time: 4:45pm-4:50pm
*Purpose: Coronary computed tomography angiography (CCTA) is an established non-invasive imaging modality for diagnosing coronary artery disease (CAD), though its use for cardiovascular disease (CVD) risk assessment prior to liver transplant (LT) remains limited. Our center has incorporated routine CCTA into our pre-LT CVD risk assessment protocol and the purpose of this study is to examine the efficacy and safety of the protocol.
*Methods: We retrospectively reviewed all patients undergoing LT evaluation at our center from 7/1/18 to 6/30/20. Patients evaluated for acute liver failure or re-transplant were excluded. Coronary artery calcium (CAC) scores, CAD reporting and data system (CAD-RADS) scores, medication administration, and adverse outcomes were collected on all patients. Patients with pre-existing CAD underwent invasive coronary angiography (ICA). Patients age >50 or age 40-50 with longstanding diabetes or >10 pack-year smoking history underwent CCTA if GFR >40 cc/min. Patients with contraindications to CCTA underwent stress echocardiogram or ICA based on CVD risk factors. CAD was defined as the presence of any atherosclerotic coronary disease. All patients with obstructive CAD, defined as any vessel >70% stenosis (or left main >50%) or lesions with positive (< 0.8) fractional flow reserve computed tomography (FFR-CT), underwent ICA.
*Results: A total of 605 patients were evaluated for LT with 278 completing CCTA, however 8 completed only CAC score due to high calcium burden. CCTA results are shown in Table 1. CAD was diagnosed in 63.8% of patients, of whom 8.5% had obstructive CAD. Median CAC scores were higher for obstructive CAD versus nonobstructive (537 [IQR 123-1300] vs 74 [IQR 13-263], p=0.019). FFR-CT was performed in 32 patients with 46.9% having a flow limiting lesion. Metoprolol was administered in 69.2% of patients to achieve adequate heart rate (<70 bpm) and nitroglycerine in 69.2% to achieve coronary hyperemia. Only 2 patient required escalation of care for hypotension. A total of 42 patients (15.2%) required ICA after CCTA.
*Conclusions: CCTA is a promising non-invasive imaging modality for detecting CAD during pre-liver transplant CVD risk assessment with a high technical success rate and low complication rates.
|CAD-RADS Score||N (%)|
|0 (No plaque or stenosis)||56 (20.7%)|
|1 (1-24% stenosis)||80 (29.6%)|
|2 (25-49% stenosis)||58 (21.5%)|
|3 (50-69% stenosis)||23 (8.5%)|
|4 (70-99% stenosis or >50% left main stenosis)||14 (5.2%)|
|5 (100% occlusion)||1 (0.4%)|
|N (Non-diagnostic)||38 (14.1%)|
To cite this abstract in AMA style:Rice J, Genders T, Groves D, Burton JR, Moloo J, Quaife R, Vargas D, Kriss M. Coronary Computed Tomography Angiography for Pre-Liver Transplant Cardiovascular Risk Assessment: A Single Center Experience [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/coronary-computed-tomography-angiography-for-pre-liver-transplant-cardiovascular-risk-assessment-a-single-center-experience/. Accessed June 12, 2021.
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