Detection of Coronary Artery Disease With Coronary Computed Tomography Angiography and Stress Testing in Candidates for Liver Transplant

Abstract

Cardiac complications are the leading cause of morbidity and mortality in liver transplant (LT) recipients. Prior guidelines recommended stress testing to exclude coronary artery disease (CAD), though recent guidelines recommend coronary computed tomography angiography (CCTA). We aimed to assess the prevalence and predictors of CAD on CCTA and compare CCTA with stress testing in consecutive adult LT candidates undergoing CAD non-invasive assessment between 2020 to 2023. Patients who underwent a stress test between 01/2020 and 12/2020 formed the stress cohort, and patients who underwent CCTA between 01/2021 and 09/2023 formed the CCTA cohort. There were 141 in the stress test cohort and 269 patients in the CCTA cohort. Stress tests were non-diagnostic or inconclusive in 18 (12.8%) whereas CCTA was non-diagnostic in 6 (2.2%) patients. In patients evaluated with CCTA, mean coronary artery calcium (CAC) score was 332 ± 716 AU, with moderate or greater (>50%) stenosis in 33 (12.3%) patients. New CAD was diagnosed in 158 (58.7%) using CCTA and in 5 (3.5%) patients using stress tests. Clinically actionable CAD (CAC >100) on CCTA was present in 96 (35.7%) patients. The number of CAD risk factors were associated with the presence of CAD on CCTA. In conclusion, there was a high burden of CAD, mainly non-obstructive, in a large cohort of LT candidates undergoing CAD testing over a 4-year period. The current recommended risk-based evaluation of LT candidates using CCTA as a first line test was feasible and effective. Diagnosis of clinically actionable CAD on CCTA provides a vast opportunity for optimizing cardiac care in LT candidates and recipients.