Key result
Coronary calcium scoring yielded a higher positive predictive value (80%) compared to dobutamine stress echocardiography (56%) for cardiac risk assessment in pre-liver transplant patients.
Why the study?
CAD is a leading cause of mortality following liver transplant, but standardized protocols for pre-transplant CAD assessment are lacking.
Does coronary calcium score (CCS) have better accuracy than dobutamine stress echocardiogram (DSE) for predicting coronary calcification in low-risk patients undergoing pre-liver transplant workup?
Observational (n=152)
Does coronary calcium score (CCS) have better accuracy than dobutamine stress echocardiogram (DSE) for predicting coronary calcification in low-risk patients undergoing pre-liver transplant workup?
In low-risk patients undergoing pre-liver transplant cardiac workup, coronary calcium scoring has a higher positive predictive value than dobutamine stress echocardiography.
Poor agreement between DSE and CCS in low-risk liver transplant candidates; leaves open whether CCS should supplant DSE in pretransplant protocols.
BACKGROUND: Coronary artery disease (CAD) is a leading cause of mortality following orthotopic liver transplant, yet there is no standardized protocol for pre-liver-transplant coronary artery disease assessment. The main objective of this study was to determine the agreement between 2 methods of cardiac risk assessment: dobutamine stress echocardiogram (DSE) and coronary calcium score (CCS) and to determine which test was best able to predict coronary calcification in low-risk patients. METHODS: A retrospective study was performed using the medical records of 436 patients who received cardiac clearance for a liver transplant. A total of 152 patients' medical records were included based on the inclusion of patients who had received both DSE and CCS. A kappa coefficient was calculated to determine the agreement between the DSE and CCS results. In addition, the positive predictive values (PPVs) of both the CCS and DSE along with cardiac catheterization indicating abdominal occlusion were analyzed to compare the accuracy of the 2 tests. RESULTS: It was determined that there was a 12% agreement between DSE results and CCS. It was found that the DSE had a PPV of 56% and the CCS had a PPV of 80%. CONCLUSION: From this data, it was concluded that there was no agreement between the results of the CCS and the DSE. While neither the CCS nor the DSE presents an optimal method of risk assessment, the CCS had a much higher PPV and was therefore determined to be the more accurate test.
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Buggs et al. (2020) conducted an observational in Pre-liver transplant coronary artery disease (n=152). Coronary calcium score (CCS) vs. Dobutamine stress echocardiogram (DSE) was evaluated on Agreement between DSE and CCS results and positive predictive value (PPV) for predicting coronary calcification (12% agreement). Coronary calcium scoring yielded a higher positive predictive value (80%) compared to dobutamine stress echocardiography (56%) for cardiac risk assessment in pre-liver transplant patients.
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