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Research Article
A single-center study: Predictive accuracy of Positron Emission Tomography (PET) stress testing for ischemic cardiac complications in liver transplant patients
1 Department of Hospital Medicine, Cypress Fair Banks Medical Center, Houston, Texas, USA
2 Imo State University, Owerri, Nigeria
3 Emory University, Atlanta, Georgia, USA
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Okechukwu Mgbemena
Department of Hospital Medicine, Cypress Fair Banks Medical Center, 10655 Steepletop Dr, Houston, Texas 77065,
USA
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Article ID: 100011C03OM2019
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How to cite this article
Mgbemena O, Njoku C, Sears I, Okoroafor C, Wedd J. A single-center study: Predictive accuracy of Positron Emission Tomography (PET) stress testing for ischemic cardiac complications in liver transplant patients. Edorium J Cardiol 2019;5:100011C03OM2019.ABSTRACT
Aims: Posttransplant cardiac complications are well-known adverse events constituting a major cause of morbidity and mortality in patients undergoing liver transplantation regardless of etiology of chronic liver disease. To determine the predictive accuracy of Positron Emission Tomography (PET) stress testing for postoperative ischemic cardiac events in patients undergoing liver transplantation.
Methods: We evaluated 60-day postoperative cardiac complications for patients who had undergone PET stress testing for preoperative evaluation. Patients with end-stage liver disease (ESLD) who underwent liver transplantation between 2009 and 2015 were reviewed. Patient demographics, risk factors, and short-term postoperative cardiac complications were collected and statistical analysis was performed.
Results: A total of 31 patients (25 [81%] men and 6 (19%) women) with a mean age at transplantation of 55.3 year (range 38–67) were identified. Cardiac risk factors included diabetes 15 (48%), hypertension 16 (52%), and current/ former tobacco use 17 (55%). Contributing factors to ESLD were chronic HCV infection 17 (55%), alcohol abuse 9 (29%), NASH 9 (29%); PSC/ cholangiocarcinoma 1 (3%), sarcoidosis 1 (3%), and cryptogenic 1 (3%). Calculated MELD score for patients with preoperative labs ranged from 10.1 to 29.2. All 31 patients had a PET stress testing for preoperative assessment. 29 (93%) had a negative stress test. Post liver transplantation, only 1 (3%) patient had third degree atrioventricular (AV) blocks attributable to ischemia at 60-day followup. Other notable postoperative complications include hypotension 5 (16%), acute renal failure 5 (16%), acute pulmonary edema 2 (6%) and congestive heart failure 4 (13%).
Conclusion: PET stress testing has a high negative predictive value for postoperative acute coronary syndromes in liver transplant patients (Negative Predictive Value (NPV) = 96.5%, 95% confidence interval (CI) 96.22–96.88%).
Keywords: Cardiac pre-operative risk evaluation, Positron emission tomography, Stress testing
SUPPORTING INFORMATION
Author Contributions
Okechukwu Mgbemena - Substantial contributions to conception and design, Interpretation of data, Drafting the article, Final approval of the version to be published
Cornelius Njoku - Substantial contributions to conception and design, Interpretation of data, Drafting the article, Final approval of the version to be published
Isaac Sears - Substantial contributions to conception and design, Interpretation of data, Drafting the article, Final approval of the version to be published
Chidi Okoroafor - Substantial contributions to conception and design, Interpretation of data, Drafting the article, Final approval of the version to be published
Joel Wedd - Substantial contributions to conception and design, Interpretation of data, Drafting the article, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2019 Okechukwu Mgbemena et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
