Role of Coronary Angiography in Pre–Liver Transplantation Cardiac Evaluation: Experience From an Asian Transplant Institution
| Autor: | Krishnakumar Madhavan, C.C.R. Wong, L.T.T. Pan, K.Y.S. Chang, Iyer Shridhar Ganpathi, J.H. Law, Wei Chieh Alfred Kow, B.L.K. Lim, N.Q. Pang |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Liver Cirrhosis Male medicine.medical_specialty medicine.medical_treatment Myocardial Ischemia Transplants Comorbidity Coronary Artery Disease Liver transplantation Coronary Angiography Left ventricular hypertrophy Sensitivity and Specificity Diabetes Complications End Stage Liver Disease Coronary artery disease Young Adult Asian People Predictive Value of Tests Risk Factors Internal medicine Diabetes mellitus medicine Humans cardiovascular diseases Aged Dyslipidemias Transplantation Univariate analysis Framingham Risk Score business.industry Middle Aged medicine.disease Liver Transplantation Logistic Models Cardiovascular Diseases Hypertension Cardiology Female Hypertrophy Left Ventricular Surgery business Dyslipidemia |
| Zdroj: | BASE-Bielefeld Academic Search Engine |
| ISSN: | 0041-1345 |
| DOI: | 10.1016/j.transproceed.2017.04.021 |
| Popis: | Liver transplant (LT) patients with significant coronary artery disease (CAD) have poorer outcomes. Pre-LT coronary angiography (CA) is associated with significant complications in cirrhotic patients.This study aimed to identify predictors of abnormal CA in pre-LT cardiac assessment and to develop a predictive model to reduce unnecessary CA. From January 2006 to June 2013, 122 patients underwent CA based on the current institutional protocol.Forty-one (33.6%) patients had abnormal CA. Univariate analysis showed age ≥65 years (P = .001), cryptogenic cirrhosis (P = .046), cardiac comorbidities (P = .027), ischemic heart disease (IHD; P = .002), left ventricular hypertrophy (LVH; P = .004), hypertension (P = .002), diabetes mellitus (P = .017), dyslipidemia (P .001), metabolic syndrome (P = .003), ≥2 CAD risk factors (P = .001), and high Framingham risk score (hard CAD risk, P = .018; cardiovascular disease: lipids, P = .002; body mass index, P .001) to be significant predictors of abnormal CA. A predictive model was developed with the use of multivariable logistic regression and included diabetes, dyslipidemia, IHD, age ≥65 years, and LVH, achieving a specificity of 55.1% and sensitivity of 90.0%. This would reduce unnecessary CA by up to one-half in our study population (from 81 to 35) while maintaining a false negative rate of only 8.5%.Diabetes, dyslipidemia, IHD, age ≥65 years, and LVH appear to be predictors of abnormal CA in pre-LT patients. Our predictive model may help to better select patients for CA, although further validation is required. |
| Databáze: | OpenAIRE |
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