Meta-Analysis
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2018; 10(11): 877-886
Published online Nov 27, 2018. doi: 10.4254/wjh.v10.i11.877
Cardiac stress testing and coronary artery disease in liver transplantation candidates: Meta-analysis
Jonathan Soldera, Fábio Camazzola, Santiago Rodríguez, Ajacio Brandão
Jonathan Soldera, Fábio Camazzola, School of Medicine, Universidade de Caxias do Sul (UCS), Caxias do Sul 95070-560, Brazil
Jonathan Soldera, Santiago Rodríguez, Ajacio Brandão, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
Ajacio Brandão, Liver Transplantation Group, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
Author contributions: Soldera J and Brandão A contributed to study concept and design, and drafting of the manuscript; Soldera J, Camazzola F and Rodríguez S contributed to acquisition of data, analysis and interpretation of data; Soldera J contributed to statistical analysis; Brandão A contributed to study supervision; all authors contributed to critical revision of the manuscript for important intellectual content.
Conflict-of-interest statement: Dr. Soldera has nothing to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jonathan Soldera, MSc, Associate Professor, School of Medicine, Universidade de Caxias do Sul (UCS), Av. Vereador Mário Pezzi, 699/601, Caxias do Sul 95070-560, Brazil. jonathansoldera@gmail.com
Telephone: +55-54-991028181
Received: July 17, 2018
Peer-review started: July 17, 2018
First decision: August 20, 2018
Revised: September 13, 2018
Accepted: October 11, 2018
Article in press: October 11, 2018
Published online: November 27, 2018
Abstract
AIM

To evaluate the diagnostic value of dobutamine stress echocardiography (DSE) and myocardial perfusion scintigraphy (MPS) in predicting coronary artery disease (CAD) in cirrhotic patients listed for liver transplantation (LT), using invasive coronary angiography (ICA) as gold-standard.

METHODS

Retrieval of studies was based on Medical Subject Headings and Health Sciences Descriptors, which were combined using Boolean operators. Searches were run on the electronic databases Scopus, Web of Science, EMBASE, MEDLINE (PubMed), BIREME (Biblioteca Regional de Medicina), LILACS (Latin American and Caribbean Health Sciences Literature), Cochrane Library for Systematic Reviews and Opengray.eu. There was no language or date of publication restrictions. The reference lists of the studies retrieved were searched manually.

RESULTS

The search strategy retrieved 322 references for DSE and 90 for MPS. In the final analysis, 10 references for DSE and 10 for MPS were included. Pooled sensitivity was 28% and 61% for DSE and MPS and specificity was 82% and 74%, for diagnosis of CAD using ICA as gold-standard, respectively.

CONCLUSION

DSE and MPS do not have adequate sensitivity for determination of whether CAD is present, despite having significant specificity.

Keywords: Myocardial perfusion imaging, Coronary angiography, Liver transplantation, Echocardiography, Stress

Core tip: The concept of cardiac involvement in cirrhotic patients has been changing as patients listed for liver transplantation (LT) have become older and sicker. We aimed to evaluate the diagnostic value of dobutamine stress echocardiography (DSE) and myocardial perfusion scintigraphy (MPS) in predicting coronary artery disease (CAD) in cirrhotic patients listed for LT, using invasive coronary angiography as gold-standard. A systematic review and meta-analysis was performed, including 10 references for DSE and 10 for MPS. We concluded that DSE and MPS do not have adequate sensitivity for determination of whether CAD is present, despite having significant specificity.