Etiology-specific Coronary Artery Calcium Score thresholds for cardiovascular risk stratification in liver transplant candidates.

Screening for coronary artery disease (CAD) in liver transplant candidates is challenging and often inefficient, with many unnecessary invasive tests. The Coronary Artery Calcium (CAC) Score has been proposed as a risk marker for CAD, but its predictive value in this specific population is not well studied. This study aims to examine clinical differences in transplant candidates with elevated CAC-Scores (≥400) compared to those with lower scores and to propose new CAC-Score cut-offs tailored to different cirrhosis etiologies for identifying patients with significant CAD who may benefit from revascularization. Out of 239 patients undergoing evaluation at the POIT of San Camillo Forlanini Hospital, 151 underwent coronary CT to measure CAC-Score, excluding those with pre-existing stents or other exclusion criteria. Patients were divided into two groups (CAC-Score ≥400 and <400) to compare clinical variables. Patients with CAC-Scores ≥400 were older on average (60 vs. 59 years, p = 0.036) and had a higher prevalence of previous CAD (p = 0.02), while other traditional risk factors showed no significant differences. Analysis by cirrhosis etiology revealed that elevated CAC-Scores were more frequent in patients with alcohol-related cirrhosis (POTUS, p = 0.004), whereas no significant associations were observed in patients with viral cirrhosis or MASLD. Additionally, patients with CAC-Scores ≥400 had significantly more areas of fibrosis (LGE) on cardiac MRI compared to those with lower scores (p = 0.037). ROC curves were generated to define optimal cut-offs for each etiology. For MASLD, the optimal cut-off was 150 (AUC 0.79, p = 0.05); for viral hepatitis, 234 (AUC 0.877, p = 0.003); and for POTUS, 696 (AUC 0.733, p = 0.005). Tailored CAC-Score cut-offs based on cirrhosis etiology could improve diagnostic accuracy in liver transplant candidates, reducing unnecessary coronary angiographies and enabling a more targeted diagnostic approach. [ABSTRACT FROM AUTHOR]