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2. Femoral Artery Closure Devices vs Manual Compression During Cardiac Catheterization and Percutaneous Coronary Intervention

Author

Kreutz, Rolf P., Phookan, Sujoy, Bahrami, Hamid, Sinha, Anjan K., Breall, Jeffrey A., Revtyak, George E., Ephrem, Georges, Zenisek, Joseph R., Frick, Kyle A., Jaradat, Ziad A., Abu Romeh, Ibrahim S., O’Leary, Brian A., Ansari, Hamza Z., Ferguson, Andrew D., Zawacki, Kevin E., Hoque, Mohammad Z., Iqtidar, Ali F., Lambert, Nathan D., and von der Lohe, Elisabeth

Published
2022
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10. Assessment of Vascular and Valvular Calcification Improves Screening for Coronary Artery Disease Before Liver Transplantation.

Author

Arman HE, Ali SA, Zenisek J, Patidar KR, Orman E, Elsner N, Ofner S, Li X, Kubal C, and Frick K

Subjects
Humans, Case-Control Studies, Coronary Angiography methods, Coronary Artery Disease complications, Coronary Artery Disease diagnosis, Coronary Artery Disease surgery, Liver Transplantation, Calcinosis diagnosis, Calcinosis diagnostic imaging, Diabetes Mellitus, Insulins, Vascular Calcification complications, Vascular Calcification diagnostic imaging
Abstract

Coronary artery disease (CAD) is common in patients with cirrhosis who underwent orthotopic liver transplantation (OLT) evaluation and stress echocardiogram (echo) has a low sensitivity in these patients. This study aimed to assess the impact of vascular and valvular calcification on the ability to identify CAD before OLT. We performed a case-control study of 88 patients with and 97 without obstructive CAD who underwent OLT evaluation. All patients had a preoperative stress echo, abdominal computed tomography, and cardiac catheterization. A series of nested logistic regression models of CAD were fit by adding independent variables of vascular (including coronary) calcification, aortic and mitral valve calcification, age, gender, and history of diabetes mellitus requiring insulin to a baseline model of abnormal stress echo. Compared with stress echo alone, identification of the presence or absence of vascular and valvular calcification on routine preoperative computed tomography and echo improved the diagnostic performance for the detection of CAD based on coronary angiogram when combined with stress echo in patients with cirrhosis who underwent OLT evaluation (area under the curve 0.58 vs 0.73, p <0.001), which is even further improved when age, gender, and history of diabetes mellitus requiring insulin are considered (area under the curve 0.58 vs 0.80, p <0.001). Achieving target heart rate (p = 0.92) or rate-pressure product >25,000 (p = 0.63) did not improve the ability of stress echo to identify CAD. In conclusion, the use of abdominal vascular, coronary artery, and valvular calcification, along with stress echo, improves the ability to identify and rule out obstructive CAD before OLT compared with stress echo alone., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Published
2023
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