Significance of Abnormal Myocardial Perfusion Scans in Candidates for Orthotopic Liver Transplantation

Abstract

Background: The implications of cardiac risk stratification before orthotopic liver transplantation (OLT) are not well established. We studied the usefulness of myocardial perfusion imaging (MPI) in this scenario.
Methods: MPI data of 24 patients (9 females), candidates of OLT, were collected. They underwent MPI as part of their preoperative risk assessment. MPIs were interpreted by 2 nuclear physicians, who had access to clinical data, scan, and semi-quantification results (i.e., quantitative perfusion single-photon emission tomography (SPECT) [QPS] and quantitative gated SPECT [QGS]). A 3rd nuclear physician, blinded to the clinical history of the subjects, re-reviewed the scans. The visual interpretations of MPI (i.e., normal vs. abnormal), ejection fraction, and transient ischemic dilation index derived from QPS and clinical and follow-up data were collected and analyzed.
Results: The follow-up period was 231.0 ± 86.0 days.  The MPIs were normal in 16 (66.7%) patients and abnormal in 8 (i.e., 5 mild [20.8%], 1 [4.2%] moderate, and 2 [8.3%] severe). Out of 4 patients who died during the follow-up, 1 had mild ischemia and 2 had severe ischemia. A patient who had a normal MPI died due to noncardiac reasons. A patient with abnormal MPI had 3-vessel disease on angiography. Out of the 5 patients who died or had significant coronary angiographic abnormalities, 4 had abnormal MPIs (negative predictive value = 93.8%; sensitivity = 80.0%)  The MPIs of 4 patients without perioperative mortality or cardiac morbidity were abnormal (specificity = 78.9%).
Conclusion: MPI seems to be remarkable in discriminating high-risk OLT patients preoperatively.