Abstract 11773: Liver Transplant Candidates: To Stress or Not to Stress?
Background: The prevalence of coronary artery disease (CAD) in patients with end stage liver disease (ESLD) and the incidence of acute coronary syndromes (ACS) post liver transplantation (LT) remain controversial. Current AHA/ACC guidelines recommend non-invasive stress testing (NIST) for risk stratification of LT recipients based on conventional cardiovascular risk factors (CVRF). The aim of our study was to define the role of NIST in the pre-transplant evaluation of ESLD patients.
Methods: We retrospectively reviewed the data of 366 patients who were referred to the Cleveland Clinic LT center between the years 2006 and 2008. We collected demographic data, CVRF, NIST, left heart catheterization (LHC) results, incidence of ACS and death.
Results: In our study population, the mean age was 56±8 years, 68% were males, 83% Caucasian, 34% diabetic, 36% hypertensive, 22% smokers, 17% had hyperlipidemia, 11% known CAD, and 14% had family history of premature CAD; overall, 70% of the patients had at least 3 CVRF. Mean platelet count was 104±70 k/uL, mean INR 1.4 ±0.4, total cholesterol (TC) 143±45 mg/dL and 42% were on beta blockers (BB).
A total of 270 patients underwent NIST with dobutamine stress echocardiography (DSE) or nuclear stress testing. DSE was diagnostic in 76% of the cases and nuclear stress test was performed in 52% of the patients with a non-diagnostic DSE. From the patients with diagnostic NIST, 40 underwent LHC. There were 5 true positive, 22 true negative, 8 false positive, and 5 false negative results giving NIST a negative predictive value of 81%.
After a median follow-up of 6.2 years [IQR 3.4 to 6.7], 264 patients were transplanted, 9 patients developed an ACS and only one of them within the first year of LT. ACS was the cause of death in one patient which occurred more than 3 years from LT. All of these patients had a prior negative NIST. There were no ACS in the non-transplanted group.
Conclusions: In our ESLD population, NIST had a limited role in the CV risk assessment of LT candidates. This is probably secondary to the low incidence of ACS which could be explained by inherent ESLD factors like thrombocytopenia, low TC, and elevated INR.
Author Disclosures: A. Ibrahim: None. A. Schuster: None. M. Alraies: None. A. Sonny: None. J.B. Cywinski: None. W.A. Jaber: None.
- © 2014 by American Heart Association, Inc.