*Purpose: Optimal cardiovascular (CV) risk stratification in liver transplant (LT) candidates remains unclear. The aim of this study was to assess concordance and utility of findings between dobutamine stress echo (DSE), positron emission tomography/computed tomography myocardial perfusion imaging (PET/CT MPI) and left heart catheterization (LHC) in LT candidates. Secondary aims were to evaluate CV testing results in relationship to 6-month post LT CV outcomes.

*Methods: Data on 234 consecutive adult LT candidates evaluated between February 2015 thru June 2018 with PET/CT MPI was reviewed. CV outcomes were adjudicated by a board certified cardiologist.

*Results: Median age was 60.8, 61% were male, 87% white, 54% had diabetes, median MELD-Na 14, and body mass index (BMI) 30.2 kg/m². 37% had NASH and 29% alcoholic liver disease. 65% of patients had a DSE, with 41% non-diagnostic. No factors were independently associated with likelihood of having a non-diagnostic DSE. The median global myocardial flow reserve (MFR) was 1.8 ml/min and correlated positively with hemoglobin and negatively with MELD-Na, age, ejection fraction and BMI. 32 (13%) patients had moderate/high risk MPI results and associations with these findings are shown in Table 1. Older age and a history of CV disease were independently associated with moderate/high risk MPI findings. In patients with 2 testing modalities, findings were concordant in 80% (Table 2). 53 patients underwent LT and 11 had a CV complication. No factors were independently associated with risk of outcomes.

*Conclusions: Cardiac risk stratification was concordant across modalities the majority of the time in LT candidates. PET/CT MPI may be the initial CV risk stratification modality of choice in older patients and those with a history of CV disease.

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