913-121 Cardiac Risk Assessment in Liver Transplant Candidates is not Cost-effective

The cost-effectiveness of preoperative noninvasive screening to detect occult coronary artery disease in asymptomatic cohorts has been questioned. We sought to evaluate the efficacy of noninvasive radionuclide testing of myocardial perfusion and function in patients with end-stage liver disease who were referred for nuclear cardiology testing prior to liver transplantation. Seventy of 222 (32%) consecutively transplanted patients had stress perfusion imaging and/or radionuclide angiography (RNA) performed prior to transplantation; 28 patients had imaging with thallium-201 and 10 with technetium-99m sestamibi. Of these 38 patients (mean age: 53±1.6 years; 11 females), 24 had an exercise stress and 14 had a pharmacological stress, either with dipyridamole (11) or dobutamine (3), which was well tolerated even with marked liver failure. Only 5 patients (13%) had a positive scan for ischemia; four scans were interpreted as low risk, with a defect seen in only one scan segment. Only 1 patient was catheterized. Of 28 patients who underwent RNA for detection of a cardiomyopathy (age: 50±1.9 years), only 1 with a known prior myocardial infarction (3.6%) had an ejection fraction <50% and regional wall motion abnormalities. Mean ejection fraction in this group was 63±1.8%. Among the 70 patients followed, there were no perioperative cardiac deaths.Thus, neither preoperative stress perfusion imaging nor RNA appear useful for risk stratification for screening patients prior to liver transplantation. Most such patients have normal studies and a favorable outcome