# Coronary Computed Tomography Angiography (CTA) in the Diagnostic Triage of Patients Undergoing Liver Transplantation: A Long-term Outcome Study

## TL;DR

This study shows that coronary CTA helps assess heart risk in liver transplant patients, improving survival predictions.

## Contribution

The study demonstrates that coronary CTA provides better risk stratification than CAC score for liver transplant patients.

## Key findings

- Coronary CTA stenosis severity (CAD-RADS) was strongly associated with mortality in liver transplant patients.
- Patients with CAD-RADS 0–1 had no myocardial infarctions, while all MIs occurred in CAD-RADS 2–4.
- Total plaque burden from CTA was linked to higher mortality risk in multivariate analysis.

## Abstract

Cardiovascular risk stratification is crucial in patients with end-stage liver disease (ESLD) yet the optimal noninvasive strategy remains debated. Our study aimed to assess the prognostic value of coronary computed tomography angiography (CTA) and coronary artery calcium (CAC) in patients undergoing orthotopic liver transplantation (LT).

Patients with ESLD scheduled for LT referred to coronary CTA and the CACscore were included. The primary endpoint was all-cause mortality and the secondary endpoint was myocardial infarction (MI).

Four hundred fifty-eight patients for pre-LT risk stratification were enrolled with 270 LT recipients (79.3% male; mean age 61 ± 8.5 years) finally being included. The mean follow-up was 7.5 ± 3.1 years, range: 2–13. Among 248 patients undergoing CTA, the majority (n = 173, 69.8%) had coronary artery disease (CAD) by CTA (Coronary Artery Disease—Reporting and Data System[CAD-RADS] 1–5), and n = 75 (30.2%) had no CAD. Stenosis severity was minimal-to-mild (<50%) in 112 (45.1%), intermediate (50–70%) in 44 (17.7%), and severe (>70%) in 17 (6.5%) patients. The all-cause mortality rate was 46 (17.0%) (n = 3 cardiovascular). Stenosis severity (CAD-RADS) was associated with mortality (Kaplan–Meier analysis, P < 0.001). On multivariate Cox regression, total plaque burden were associated with all-cause mortality (hazard ratio [HR]: 1.1, P = 0.034; 95% confidence interval [CI]: 0.649–0.983 and HR: 1.1, P = 0.029; 95% CI: 1.0–1.6), while the CAC score was not. Six acute myocardial infarctions (MIs, 3 ST-elevation MI [STEMI] and 3 non-STEMI) occurred, none of them (0%) in patients with CAD-RADS 0–1 and 100% CAD-RADS 2–4.

Coronary CTA is a valuable tool for pre-LT cardiovascular risk assessment. Patients with no or minimal CAD on CTA have an excellent prognosis regarding survival.

Coronary CTA enables refined risk stratification in patients undergoing liver transplantation by assessing stenosis severity and plaque burden.

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