Cardiac Risk Stratification in Liver Transplantation: Results of a Tiered Assessment Protocol Based on Traditional Cardiovascular Risk Factors.
Journal
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
ISSN: 1527-6473
Titre abrégé: Liver Transpl
Pays: United States
ID NLM: 100909185
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
revised:
14
12
2020
received:
15
09
2020
accepted:
17
12
2020
pubmed:
20
2
2021
medline:
3
8
2021
entrez:
19
2
2021
Statut:
ppublish
Résumé
Coronary artery disease (CAD) confers increased perioperative risk in patients undergoing liver transplantation (LT). Although routine screening for CAD is recommended, there are limited data on the effectiveness of screening strategies. We evaluated the safety and efficacy of a 3-tiered cardiac risk-assessment protocol that stratifies patients based on age and traditional cardiac risk factors. We peformed a single-center, prospective, observational study of consecutive adult patients undergoing LT assessment (2010-2017). Patients were stratified into low-risk (LR), intermediate-risk (IR), or high-risk (HR) cardiac groups and received standardized investigations with selective use of transthoracic echocardiography (TTE), dobutamine stress echocardiography (DSE), computed tomography coronary angiography (CTCA), and coronary angiography (CA). Primary outcomes were cardiac events (CEs) and cardiovascular death up to 30 days after LT. Overall, 569 patients were included, with 76 patients identified as LR, 256 as IR, and 237 as HR. Cardiac risk factors included diabetes mellitus (26.0%), smoking history (47.3%), hypertension (17.8%), hypercholesterolemia (7.2%), family (17.0%) or prior history of heart disease (6.0%), and obesity (27.6%). Of the patients, 42.0% had ≥2 risk factors. Overall compliance with the protocol was 90.3%. Abnormal findings on TTE, DSE, and CTCA were documented in 3, 23, and 44 patients, respectively, and 12 patients were not listed for transplantation following cardiac assessment (1 LR, 2 IR, and 9 HR). Moderate or severe CAD was identified in 25.4% of HR patients on CTCA following a normal DSE. CEs were recorded in 7 patients (1.2%), with 2 cardiovascular deaths (0.4%). Cardiac risk stratification based on traditional cardiac risk factors with the selective use of DSE, CTCA, and CA is a safe and feasible approach that results in a low perioperative cardiac event rate.
Substances chimiques
Dobutamine
3S12J47372
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1007-1018Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 by the American Association for the Study of Liver Diseases.
Références
Xia VW, Taniguchi M, Steadman RH. The changing face of patients presenting for liver transplantation. Curr Opin Organ Transplant 2008;13:280-284.
Raval Z, Harinstein ME, Skaro AI, Erdogan A, DeWolf AM, Shah SJ, et al. Cardiovascular risk assessment of the liver transplant candidate. J Am Coll Cardiol 2011;58:223-231.
VanWagner LB, Lapin B, Levitsky J, Wilkins JT, Abecassis MM, Skaro AI, Lloyd-Jones DM. High early cardiovascular mortality after liver transplantation. Liver Transpl 2014;20:1306-1316.
Mirbagheri SA, Rashidi A, Abdi S, Saedi D, Abouzari M. Liver: an alarm for the heart? Liver Int 2007;27:891-894.
Plotkin JS, Scott VL, Pinna A, Dobsch BP, De Wolf AM, Kang Y. Morbidity and mortality in patients with coronary artery disease undergoing orthotopic liver transplantation. Liver Transpl Surg 1996;2:426-430.
Diedrich DA, Findlay JY, Harrison BA, Rosen CB. Influence of coronary artery disease on outcomes after liver transplantation. Transplant Proc 2008;40:3554-3557.
VanWagner LB, Harinstein ME, Runo JR, Darling C, Serper M, Hall S, et al. Multidisciplinary approach to cardiac and pulmonary vascular disease risk assessment in liver transplantation: an evaluation of the evidence and consensus recommendations. Am J Transplant 2018;18:30-42.
Plotkin JS, Johnson LB, Rustgi V, Kuo PC. Coronary artery disease and liver transplantation: the state of the art. Liver Transpl 2000;6(suppl 1):S53-S56.
Nicolau-Raducu R, Gitman M, Ganier D, Loss GE, Cohen AJ, Patel H, et al. Adverse cardiac events after orthotopic liver transplantation: a cross-sectional study in 389 consecutive patients. Liver Transpl 2015;21:13-21.
Koshy AN, Gow PJ, Han H-C, Teh AW, Jones R, Testro A, et al. Cardiovascular mortality following liver transplantation: predictors and temporal trends over 30 years. Eur Heart J Qual Care Clin Outcomes 2020;6:243-253.
Ehtisham J, Altieri M, Salamé E, Saloux E, Ollivier I, Hamon M. Coronary artery disease in orthotopic liver transplantation: pretransplant assessment and management. Liver Transpl 2010;16:550-557.
Tiukinhoy-Laing SD, Rossi JS, Bayram M, De Luca L, Gafoor S, Blei A, et al. Cardiac hemodynamic and coronary angiographic characteristics of patients being evaluated for liver transplantation. Am J Cardiol 2006;98:178-181.
McCaughan GW. Trekking new ground: overcoming medical and social impediments for extended criteria liver transplant recipients. Liver Transpl 2012;18(suppl 2):S39-S46.
Lentine KL, Costa SP, Weir MR, Robb JF, Fleisher LA, Kasiske BL, et al. Cardiac disease evaluation and management among kidney and liver transplantation candidates: a scientific statement from the American Heart Association and the American College of Cardiology Foundation: endorsed by the American Society of Transplant Surgeons, American Society of Transplantation, and National Kidney Foundation. Circulation 2012;126:617-663.
Murray KF, Carithers RL, AASLD. AASLD practice guidelines: evaluation of the patient for liver transplantation. Hepatology 2005;41:1407-1432.
Lester SJ, Hurst RT. Liver transplantation: do you have the heart for it? Liver Transpl 2006;12:520-522.
Martin P, DiMartini A, Feng S, Brown R, Fallon M. Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Hepatology 2014;59:1144-1165.
Kutkut I, Rachwan RJ, Timsina LR, Ghabril MS, Lacerda MA, Kubal CA, et al. Pre-liver transplant cardiac catheterization is associated with low rate of myocardial infarction and cardiac mortality. Hepatology 2020;72:240-256.
Hogan BJ, Gonsalkorala E, Heneghan MA. Evaluation of coronary artery disease in potential liver transplant recipients. Liver Transpl 2017;23:386-395.
Raval Z, Harinstein ME, Skaro AI, Erdogan A, DeWolf AM, Shah SJ, et al. Cardiovascular risk assessment of the liver transplant candidate. J Am Coll Cardiol 2011;58:223-231.
Nguyen P, Plotkin J, Fishbein TM, Laurin JM, Satoskar R, Shetty K, Taylor AJ. Dobutamine stress echocardiography in patients undergoing orthotopic liver transplantation: a pooled analysis of accuracy, perioperative and long term cardiovascular prognosis. Int J Cardiovasc Imaging 2013;29:1741-1748.
Cassagneau P, Jacquier A, Giorgi R, Amabile N, Gaubert J-Y, Cohen F, et al. Prognostic value of preoperative coronary computed tomography angiography in patients treated by orthotopic liver transplantation. Eur J Gastroenterol Hepatol 2012;24:558-562.
Choi JM, Kong YG, Kang JW, Kim YK. Coronary computed tomography angiography in combination with coronary artery calcium scoring for the preoperative cardiac evaluation of liver transplant recipients. Biomed Res Int 2017;2017:1-9.
Koshy AN, Ha FJ, Gow PJ, Han H-C, Amirul-Islam FM, Lim HS, et al. Computed tomographic coronary angiography in risk stratification prior to non-cardiac surgery: a systematic review and meta-analysis. Heart 2019;105:1335-1342.
Jeong SM. Postreperfusion syndrome during liver transplantation. Korean J Anesthesiol 2015;68:527-539.
Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). Circulation 2018;138:e618-e651.
Siniscalchi A, Gamberini L, Laici C, Bardi T, Ercolani G, Lorenzini L, Faenza S. Post reperfusion syndrome during liver transplantation: from pathophysiology to therapy and preventive strategies. World J Gastroenterol 2016;22:1551-1569.
Fouad TR, Abdel-Razek WM, Burak KW, Bain VG, Lee SS. Prediction of cardiac complications after liver transplantation. Transplantation 2009;87:763-770.
Safadi A, Homsi M, Maskoun W, Lane KA, Singh I, Sawada SG, Mahenthiran JO. Perioperative risk predictors of cardiac outcomes in patients undergoing liver transplantation surgery. Circulation 2009;120:1189-1194.
Koshy AN, Farouque O, Cailes B, Ko J, Han H-C, Weinberg L, et al. Prediction of perioperative cardiovascular events in liver transplantation. Transplantation 2021;105:593-601.
Aydinalp A, Atar I, Bal U, Aktas A, Ertan C, Atar A, et al. Determinants of coronary artery disease in liver transplant candidates. Exp Clin Transplant 2010;8:142-145.
Patel S, Kiefer TL, Ahmed A, Ali ZA, Tremmel JA, Lee DP, et al. Comparison of the frequency of coronary artery disease in alcohol-related versus non-alcohol-related endstage liver disease. Am J Cardiol 2011;108:1552-1555.
Romero-Cristóbal M, Mombiela T, Caballero A, Clemente A, Fernández-Yunquera A, Diaz-Fontenla F, et al. Clinical utility of a risk-adapted protocol for the evaluation of coronary artery disease in liver transplant recipients. Liver Transpl 2019;25:e25493.
Patel SS, Nabi E, Guzman L, Abbate A, Bhati C, Stravitz RT, et al. Coronary artery disease in decompensated patients undergoing liver transplantation evaluation. Liver Transpl 2018;24:333-342.
Snipelisky D, Levy M, Shapiro B. Utility of dobutamine stress echocardiography as part of the pre-liver transplant evaluation: an evaluation of its efficacy. Clin Cardiol 2014;37:468-472.
Poulin MF, Chan EY, Doukky R. Coronary computed tomographic angiography in the evaluation of liver transplant candidates. Angiology 2015;66:803-810.
Keeling AN, Flaherty JD, Davarpanah AH, Ambrosy A, Farrelly CT, Harinstein ME, et al. Coronary multidetector computed tomographic angiography to evaluate coronary artery disease in liver transplant candidates: methods, feasibility and initial experience. J Cardiovasc Med 2011;12:460-468.