Pre-Operative Cardiovascular Testing before Liver Transplantation.

MedStar author(s):
Citation: American Journal of Cardiology. 152:132-137, 2021 08 01.PMID: 34103158Institution: MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: Advanced Cardiac Catheterization Research Fellowship | Cardiovascular Disease Fellowship | Interventional Cardiology Fellowship | Transplant Hepatology ServiceForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Coronary Angiography/sn [Statistics & Numerical Data] | *Echocardiography/sn [Statistics & Numerical Data] | *End Stage Liver Disease/su [Surgery] | *Exercise Test/sn [Statistics & Numerical Data] | *Liver Transplantation/mt [Methods] | *Myocardial Infarction/ep [Epidemiology] | *Postoperative Complications/ep [Epidemiology] | *Preoperative Care/sn [Statistics & Numerical Data] | Adult | Aged | Cardiac Catheterization | Cardiovascular Diseases/mo [Mortality] | Computed Tomography Angiography | Female | Humans | Male | Middle Aged | Mortality | Myocardial Perfusion Imaging/sn [Statistics & Numerical Data] | Myocardial Revascularization/sn [Statistics & Numerical Data] | Non-ST Elevated Myocardial Infarction/ep [Epidemiology] | Retrospective Studies | ST Elevation Myocardial Infarction/ep [Epidemiology]Year: 2021Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0002-9149
Name of journal: The American journal of cardiologyAbstract: End-stage liver disease (ESLD) is increasingly prevalent and shares many risk factors with coronary artery disease (CAD). No specific guidelines exist for pre-liver transplant evaluation of CAD, and pretransplant cardiovascular testing varies widely. The aim of this study is to characterize pre-transplant cardiac testing practices with post-transplant clinical outcomes. We retrospectively reviewed patients undergoing initial liver transplantation at our transplant center between January 2015 and March 2019. Patients with previous liver transplantation or multi-organ transplantation were excluded. Electronic medical records were reviewed for relevant demographic and clinical data. We included 285 patients with a mean follow-up of 2.4 years. Of 274 patients (96.1%) with pre-transplant transthoracic echocardiogram (TTE), 18 (6.6%) were abnormal. Non-invasive ischemic testing was performed in 193 (68%) patients: 165 (58%) underwent stress TTE, 24 (8%) underwent myocardial perfusion imaging, 3 underwent coronary computed tomography, and 1 underwent exercise electrocardiogram. Sixteen patients (6%) had left heart catheterization of which 10 (63%) were abnormal and 5 proceeded to revascularization before transplant. There were 4 (1.4%) deaths within 30 days of transplant and 23 deaths (8.1%) in total. ST-elevation myocardial infarction was seen in 1 patient within 30 days and 1 patient after 30 days (0.7% total). No cardiovascular deaths were observed. Among patients undergoing liver transplantation, pre-transplantation cardiovascular testing is exceedingly common and post-transplant cardiovascular complications are rare. Additional research is needed to determine the optimal testing and surveillance in this patient population. Copyright (c) 2021 Elsevier Inc. All rights reserved.All authors: Ben-Dor I, Bernardo NL, Case BC, Chezar-Azerrad C, Forrestal BJ, Hashim H, Kumar S, Lalos AT, Medranda GA, Qamer SZ, Rogers T, Satler LF, Satoskar RS, Waksman R, Yang M, Yerasi COriginally published: American Journal of Cardiology. 2021 Jun 05Fiscal year: FY2022Fiscal year of original publication: FY2021Digital Object Identifier: Date added to catalog: 2021-07-19
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 34103158 Available 34103158

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

End-stage liver disease (ESLD) is increasingly prevalent and shares many risk factors with coronary artery disease (CAD). No specific guidelines exist for pre-liver transplant evaluation of CAD, and pretransplant cardiovascular testing varies widely. The aim of this study is to characterize pre-transplant cardiac testing practices with post-transplant clinical outcomes. We retrospectively reviewed patients undergoing initial liver transplantation at our transplant center between January 2015 and March 2019. Patients with previous liver transplantation or multi-organ transplantation were excluded. Electronic medical records were reviewed for relevant demographic and clinical data. We included 285 patients with a mean follow-up of 2.4 years. Of 274 patients (96.1%) with pre-transplant transthoracic echocardiogram (TTE), 18 (6.6%) were abnormal. Non-invasive ischemic testing was performed in 193 (68%) patients: 165 (58%) underwent stress TTE, 24 (8%) underwent myocardial perfusion imaging, 3 underwent coronary computed tomography, and 1 underwent exercise electrocardiogram. Sixteen patients (6%) had left heart catheterization of which 10 (63%) were abnormal and 5 proceeded to revascularization before transplant. There were 4 (1.4%) deaths within 30 days of transplant and 23 deaths (8.1%) in total. ST-elevation myocardial infarction was seen in 1 patient within 30 days and 1 patient after 30 days (0.7% total). No cardiovascular deaths were observed. Among patients undergoing liver transplantation, pre-transplantation cardiovascular testing is exceedingly common and post-transplant cardiovascular complications are rare. Additional research is needed to determine the optimal testing and surveillance in this patient population. Copyright (c) 2021 Elsevier Inc. All rights reserved.

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