Abstract 12104: Routine Evaluation for Ischemic Heart Disease Prior to Liver Transplantation Does Not Add Additional Prognostic Value to Clinical Risk Assessment
Background: We retrospectively assessed the prognostic information from routine preoperative studies evaluating for ischemic heart disease (IHD) in patients undergoing liver transplantation (LT).
Methods: Consecutive patients receiving LT at a single institution between 2004 and 2008 were evaluated for cardiovascular endpoints following LT, including death from any cause, MI, heart failure (HF), arrhythmia, and all 4 outcomes as a combined endpoint. The evaluation for IHD included an assessment of ejection fraction and a stress test (ST), with invasive coronary angiography (ICA) in some cases. Logistic regression models with dichotomous responses (event by 1 year) were used to assess the value of ST and ICA data against a background of clinical variables including age, gender, MELD score, history of encephalopathy and history of atrial fibrillation.
Results: During the study period, 195 patients underwent LT. The majority (130, 66.7%) was male; mean age 53.4 ±8.9 years; mean MELD score 20.7 ±7.3. All but 13 patients (93.3%) underwent evaluation for IHD, including dobutamine echocardiography (70.3%), SPECT (32.3%), and ICA (16.9%); 27 patients (14.8%) had either an abnormal ST or ICA. Outcomes at 30 days and 1 year, respectively, were: mortality 8 (4.1%) and 25 (12.8%), HF 18 (9.2%) and 22 (11.3%), MI 20 (10.3%) and 25 (12.8%), arrhythmia 17 (8.7%) and 28 (14.4%). Age, gender, MELD score, history of encephalopathy and history of atrial fibrillation collectively had good ability to predict cardiovascular outcomes as evaluated by logistic regression, which changed minimally with the addition of ST and ICA data (Table).
Conclusions: Routine preoperative IHD evaluation does not provide significant additional prognostic value in predicting cardiovascular endpoints after LT compared to clinical data alone.
- © 2010 by American Heart Association, Inc.