YKL-40: Revolutionizing cardiac risk prediction and therapy in liver transplantation

Table 5 Diagnostic tests for cardiovascular disease detection in liver transplant candidates

Diagnostic test	Purpose	Risk stratification	Key clinical parameters
Stress echocardiography	Assesses myocardial function under stress conditions to detect ischemia and evaluate contractile reserve	Low risk: Normal stress echocardiography findings. High risk: Inducible ischemia or significant wall motion abnormalities	Utilizes exercise or pharmacologic agents to induce stress. Non-invasive functional assessment. May have limitations in cirrhotic patients due to hyperdynamic circulation leading to false-negative results
Myocardial perfusion scintigraphy (nuclear stress test)	Evaluates myocardial perfusion at rest and under stress to identify areas of reduced blood flow, aiding in the detection of silent ischemia	Low risk: No perfusion defects; High risk: Reversible perfusion defects indicating ischemia	Involves administration of radioactive tracers. Non-invasive imaging technique. Accuracy may be compromised in cirrhotic patients due to splanchnic vasodilation and hyperdynamic circulation
CCTA	Provides detailed anatomical visualization of coronary arteries to detect obstructive CAD	Low risk: No or minimal coronary artery disease. High risk: Presence of significant coronary artery stenosis	High-resolution imaging modality. Non-invasive anatomical assessment. Effective in detecting CAD in LT candidates
CAC scoring	Quantifies the burden of coronary artery calcification to stratify cardiovascular risk	Low risk: CAC score of 0. Moderate risk: CAC score 1-100. High risk: CAC score > 100	Derived from CCTA or dedicated calcium scoring CT. Non-invasive quantification of calcified plaque. Higher scores associated with increased risk of perioperative MACE
Cardiac MRI	Provides detailed images of cardiac structures and function, aiding in the assessment of myocardial viability, fibrosis, and overall cardiac function	Low risk: Normal cardiac MRI findings; High risk: Presence of myocardial fibrosis, reduced ejection fraction, or other significant abnormalities	Offers high spatial resolution images without ionizing radiation. Superior tissue characterization capabilities. Useful in detecting myocardial fibrosis and assessing ventricular function. Limited availability and higher cost may restrict widespread use

CAC: Coronary artery calcium; CAD: Coronary artery disease; CCTA: Coronary computed tomography angiography; CT: Computed tomography; LT: Liver transplant; MACE: Major adverse cardiac events; MRI: Magnetic resonance imaging.