TY  - BOOK
AU  - Ben-Dor, Itsik
AU  - Bernardo, Nelson L
AU  - Case, Brian
AU  - Chezar-Azerrad, Chava
AU  - Forrestal, Brian
AU  - Hashim, Hayder
AU  - Lalos, Alexander
AU  - Medranda, Giorgio
AU  - Qamer, Syed
AU  - Rogers, Toby
AU  - Satler, Lowell F
AU  - Waksman, Ron
AU  - Yang, Michael
AU  - Yerasi, Charan
TI  - Pre-Operative Cardiovascular Testing before Liver Transplantation
SN  - 0002-9149
PY  - 2021///
KW  - *Coronary Angiography/sn [Statistics & Numerical Data]
KW  - *Echocardiography/sn [Statistics & Numerical Data]
KW  - *End Stage Liver Disease/su [Surgery]
KW  - *Exercise Test/sn [Statistics & Numerical Data]
KW  - *Liver Transplantation/mt [Methods]
KW  - *Myocardial Infarction/ep [Epidemiology]
KW  - *Postoperative Complications/ep [Epidemiology]
KW  - *Preoperative Care/sn [Statistics & Numerical Data]
KW  - Adult
KW  - Aged
KW  - Cardiac Catheterization
KW  - Cardiovascular Diseases/mo [Mortality]
KW  - Computed Tomography Angiography
KW  - Female
KW  - Humans
KW  - Male
KW  - Middle Aged
KW  - Mortality
KW  - Myocardial Perfusion Imaging/sn [Statistics & Numerical Data]
KW  - Myocardial Revascularization/sn [Statistics & Numerical Data]
KW  - Non-ST Elevated Myocardial Infarction/ep [Epidemiology]
KW  - Retrospective Studies
KW  - ST Elevation Myocardial Infarction/ep [Epidemiology]
KW  - MedStar Heart & Vascular Institute
KW  - MedStar Washington Hospital Center
KW  - Advanced Cardiac Catheterization Research Fellowship
KW  - Cardiovascular Disease Fellowship
KW  - Interventional Cardiology Fellowship
KW  - Transplant Hepatology Service
KW  - Journal Article
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
N2  - 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
UR  - https://dx.doi.org/10.1016/j.amjcard.2021.04.012
ER  -