Improved heart screening for liver transplant patients using regular chest CT scans

As we all know calcium buildup in coronary arteries, as seen in dedicated heart scans, is a strong indicator of future heart problems. But can coronary artery calcium (CAC) be observed in regular chest CT scans? Could it predict heart disease severity and patient outcomes? Moreover, can that information become a biomarker for transplant recipients??

Today we’d like to invite you to look at a paper titled Coronary artery calcium assessment on non-gated chest CT to optimize pre-operative cardiac screening in liver transplantation [1] published a couple of weeks ago in the International Journal of Cardiology.??

The problem of underreporting calcium findings?

Coronary artery disease (CAD) is responsible for more deaths than any other disease worldwide and imposes a substantial economic burden on healthcare systems worldwide. Approximately 1 in 30 patients with stable CAD experiences cardiovascular death or myocardial infarction (MI) each year [2].??

Last year a group of researchers looked back at patients who had both a regular chest scan and a heart scan due to a heart attack and measured calcium buildup in both scans using different methods [3]. Results? In over 100 patients, calcium buildup in chest scans was linked to more severe heart disease and higher death rates. The amount of calcium accurately predicted heart disease severity. The mentioned study aimed to confirm the link between chest scan calcium and heart disease severity and to highlight the problem of underreporting calcium findings. While calcium was often seen in chest scans, it was rarely mentioned in the reports. While this information is valuable for preventing heart problems, doctors often overlook it in scan reports. Moreover, despite the importance of checking for calcium in chest scans, many doctors don't do it.??

Coronary artery calcium (CAC) from chest CT as a biomarker in liver transplant recipients??

Current guidelines suggest that all patients undergoing a liver transplant should have cardiac imaging or ICA before surgery, even though heart problems are not very common in this group. Many of these patients already have chest CT done as part of their routine care. The study by Roos A. Groen et al. [1] aimed to find out if it's possible to use the calcium buildup information from existing chest CT scans to identify patients who are unlikely to have heart problems and therefore don't need extra tests.?

For this analysis researchers retrospectively screened patients who underwent cardiac pre-operative screening before liver transplantation between 2008 and 2023 at the Leiden University Medical Center (LUMC).??

The researchers found that by examining calcium buildup in regular chest scans, they could successfully identify a group of patients who were unlikely to have heart problems. This means that these patients could safely skip additional heart tests.?

Roos A. Groen et al. translated the results into a clinical practice and proposed a decision tree.

By including a system that initially checks for calcium buildup in heart arteries using existing non-heart-related scans as a first step in heart screening for liver transplant patients, it might be possible to develop a standardized approach for evaluating heart health in these patients. This could become a recommended practice for all surgeries, not just liver transplants.?

?

References:?

[1] Groen R.A., Barbero F.L., Fischer S.E., van Dijkman P.R.M., Bax J.J., Tushuizen M.E., Jukema J.W., Coenraad M.J., de Graaf M.A., Coronary artery calcium assessment on non-gated chest CT to optimize pre-operative cardiac screening in liver transplantation, International Journal of Cardiology, Volume 407, 2024, 132015, ISSN 0167-5273, https://doi.org/10.1016/j.ijcard.2024.132015.??

[2] Stergiopoulos K., Boden W.E., Hartigan P., M?bius-Winkler S., Hambrecht R., Hueb W., Hardison R.M., Abbott J.D., Brown D.L. Percutaneous coronary intervention outcomes in patients with stable obstructive coronary artery disease and myocardial ischemia: a collaborative meta-analysis of contemporary randomized clinical trials. JAMA Intern Med. 2014 Feb 1;174(2):232-40. DOI:?10.1001/jamainternmed.2013.12855.?

[3] Silva B.V., Menezes M.N., Plácido R., Jorge C., Rigueira J., Garcia A.B., Martins A.M., Oliveira C., Abrantes A., Pinto F.J., Almeida A.G., Coronary Artery Calcium Identified on Non-Gated Chest CT Scans: A Wasted Opportunity for Preventive Cardiological Care, Heart, Lung and Circulation, Volume 32, Issue 11, 2023, Pages 1312-1320, ISSN 1443-9506, https://doi.org/10.1016/j.hlc.2023.09.016.??