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Sampaio Rodrigues T, Koshy AN, Gow PJ, Weinberg L, Cailes B, Testro A, Smith G, Lim HS, Teh AW, Lim RP, Farouque O. Atherosclerosis on CT coronary angiography and the risk of long-term cardiovascular events after liver transplantation. Liver Transpl 2024; 30:182-191. [PMID: 37432891 DOI: 10.1097/lvt.0000000000000215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023]
Abstract
Computed tomography coronary angiography (CTCA) is increasingly utilized for preoperative risk stratification before liver transplantation (LT). We sought to assess the predictors of advanced atherosclerosis on CTCA using the recently developed Coronary Artery Disease-Reporting and Data System (CAD-RADS) score and its impact on the prediction of long-term major adverse cardiovascular events (MACE) following LT. We conducted a retrospective cohort study of consecutive patients who underwent CTCA for LT work-up between 2011 and 2018. Advanced atherosclerosis was defined as coronary artery calcium scores > 400 or CAD-RADS score ≥ 3 (≥50% coronary artery stenosis). MACE was defined as myocardial infarction, heart failure, stroke, or resuscitated cardiac arrest. Overall, 229 patients underwent CTCA (mean age 66 ± 5 y, 82% male). Of these, 157 (68.5%) proceeded with LT. The leading etiology of cirrhosis was hepatitis (47%), and 53% of patients had diabetes before transplant. On adjusted analysis, male sex (OR 4.6, 95% CI 1.5-13.8, p = 0.006), diabetes (OR 2.2, 95% CI 1.2-4.2, p = 0.01) and dyslipidemia (OR 3.1, 95% CI 1.3-6.9, p = 0.005) were predictors of advanced atherosclerosis on CTCA. Thirty-two patients (20%) experienced MACE. At a median follow-up of 4 years, CAD-RADS ≥ 3, but not coronary artery calcium scores, was associated with a heightened risk of MACE (HR 5.8, 95% CI 1.6-20.6, p = 0.006). Based on CTCA results, 71 patients (31%) commenced statin therapy which was associated with a lower risk of all-cause mortality (HR 0.48, 95% CI 0.24-0.97, p = 0.04). The standardized CAD-RADS classification on CTCA predicted the occurrence of cardiovascular outcomes following LT, with a potential to increase the utilization of preventive cardiovascular therapies.
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Affiliation(s)
- Thalys Sampaio Rodrigues
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Paul J Gow
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Laurence Weinberg
- Department of Anesthesiology, Austin Health, Melbourne, Victoria, Australia
| | - Benjamin Cailes
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Adam Testro
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Gerard Smith
- Department of Radiology, Austin Health, Melbourne, Victoria, Australia
| | - Han S Lim
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Andrew W Teh
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Ruth P Lim
- Department of Radiology, Austin Health, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
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Koshy AN, Nerlekar N, Gow PJ, Lim R, Smith G, Galea M, Rodriques TS, Lim HS, Teh A, Farouque O. A prospective natural history study of coronary atherosclerosis following liver transplantation. Atherosclerosis 2022; 344:40-48. [DOI: 10.1016/j.atherosclerosis.2022.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 11/24/2022]
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Koshy AN, Gow PJ, Han HC, Teh AW, Lim HS, Testro A, Jones R, Farouque O. Sudden cardiac death following liver transplantation: Incidence, trends and risk predictors. Int J Cardiol 2020; 327:171-174. [PMID: 33253736 DOI: 10.1016/j.ijcard.2020.11.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/31/2020] [Accepted: 11/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cardiovascular events are a leading cause of mortality following liver transplantation (LT). Although a preponderance of sudden cardiac death (SCD) in this population has been reported, there is a paucity of data evaluating the incidence, timing and predictors of SCD following LT. METHODS Using the prospectively collected Australian and New Zealand Liver Transplant Registry, a cohort study of all adult LTs from 1985 to 2017 was performed to ascertain the incidence and predictors of SCD. Recipient cause of death was adjudicated by an interdisciplinary panel. RESULTS 4265 LT patients were followed-up for 37,409 person-years. SCD was the leading mode of cardiovascular death with an incidence rate of 165 per 100,000 person-years. There was a significant increase in the hazard of SCD in the contemporary (1996-2017) vs early era (1985-1995) (hazard ratio [HR] 2.42, 95%CI 1.10-5.40; p = 0.02). On Cox regression after adjusting for significant univariate predictors including age, coronary artery disease and non-alcoholic steatohepatitis, pre-transplant diabetes was the only independent predictor of SCD (HR 2.5 95%CI 1.1-6.0). CONCLUSION SCD is the leading mode of cardiovascular cause-specific mortality following LT and diabetes was associated with a two-fold higher risk for its occurrence. Given the escalating cardiovascular risk factor profile of LT candidates, targeted therapies especially in patients with diabetes are needed to mitigate risk of post-transplant SCD.
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Affiliation(s)
- Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Paul J Gow
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Hui-Chen Han
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Andrew W Teh
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Han S Lim
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Adam Testro
- Department of Medicine, The University of Melbourne, Victoria, Australia; Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Robert Jones
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia.
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Gitto S, Andreone P. Targeted pharmacotherapy for cardiovascular risk reduction in patients with diabetes undergoing liver transplantation: Author's reply. Eur J Intern Med 2020; 80:105. [PMID: 32768161 DOI: 10.1016/j.ejim.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/01/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Stefano Gitto
- Department of Experimental and Clinical Medicine, University of Florence, Italy.
| | - Pietro Andreone
- Internal and Metabolic Medicine, AOU di Modena and University of Modena and Reggio Emilia, Italy
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