Accuracy of stress myocardial perfusion imaging to diagnose coronary artery disease in end stage liver disease patients

Suchit Bhutani, Jonathan Tobis, Rubine Gevorgyan, Arjun Sinha, William Suh, Henry M. Honda, Gabriel Vorobiof, René R.S. Packard, Randolph Steadman, Christopher Wray, Ronald Busuttil, Chi Hong Tseng

Research output: Contribution to journalArticlepeer-review

51 Scopus citations


Patients with end-stage liver disease (ESLD) who also have underlying coronary artery disease (CAD) may be at increased risk for undergoing hemodynamically challenging orthotopic liver transplantation. Noninvasive single-photon emission computed tomographic (SPECT) imaging is often used to determine whether a patient with ESLD has unsuspected CAD. The objective of this study was to determine the accuracy of SPECT imaging for detection of CAD in patients with ESLD. Patients with ESLD who underwent coronary angiography and SPECT imaging before orthotopic liver transplantation were analyzed retrospectively. The predictive accuracy of clinical risk factors was calculated and compared to the results of SPECT imaging. There were 473 SPECT imaging studies. Adenosine SPECT imaging had a sensitivity of 62%, specificity of 82%, positive predictive value of 30%, and negative predictive value of 95% for diagnosing severe CAD. Regadenoson SPECT imaging had a sensitivity of 35%, specificity of 88%, positive predictive value of 23%, and negative predictive value of 93% for diagnosing severe CAD. The accuracy of a standard risk factor analysis showed no statistical difference in predicting CAD compared with adenosine (sensitivity McNemar's p = 0.48, specificity McNemar's p = 1.00) or regadenoson (sensitivity McNemar's p = 0.77, specificity McNemar's p = 1.00) SPECT studies. In conclusion, the 2 pharmaceutical agents had low sensitivity but high specificity for diagnosing CAD. However, because the sensitivity of the test is low, the chances of missing patients with ESLD with CAD is high, making SPECT imaging an inaccurate screening test. A standard risk factor analysis as a predictor for CAD in patients with ESLD is less expensive, has no radiation exposure, and is as accurate as SPECT imaging.

Original languageEnglish (US)
Pages (from-to)1057-1061
Number of pages5
JournalAmerican Journal of Cardiology
Issue number7
StatePublished - Apr 1 2013

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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