Liver Failure, Myocardial Perfusion Imaging
Conditions
Brief summary
The optimal screening strategy for assessment of coronary artery disease in patients with end-stage liver disease (ESLD) is unclear. Although consensus based guidelines support noninvasive stress testing prior to orthotopic liver transplantation (OLT), no prospective studies are available to inform the clinician on perioperative risk stratification. This observational cohort study was designed to determine the prognostic utility of single photon emission computed tomography (SPECT) imaging in OLT candidates.
Detailed description
Controversy over whether SPECT imaging offers clinical utility in ESLD has been fuelled by conflicting reports on its accuracy to diagnose CAD in this setting. Moreover, there are no studies examining whether SPECT imaging provides any incremental prognostic value beyond functional testing in this high-risk cohort. We sought to determine the relative importance of CV risk factors, functional capacity and SPECT perfusion results as independent predictors of cardiovascular mortality in OLT candidates.
Interventions
PROCEDUREMyocardial perfusion imaging
Sponsors
University Hospital Birmingham NHS Foundation Trust
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
• Liver transplantation candidates with one or more of the following: * inability to perform \>4 METs by history * insulin-treated diabetes mellitus * serum creatinine \>152μmol/l * history of MI, PCI or CABG * stable angina * cerebrovascular disease * peripheral vascular disease
Exclusion criteria
* Age \< 18 years * Pregnancy * Contraindication to liver transplantation
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Cardiovascular mortality | 10 years |
Secondary
| Measure | Time frame |
|---|---|
| Major adverse cardiovascular event | 10 years |
| All-cause mortality | 10 years |
Outcome results
None listed