ArticleCureus2026
Limited Sensitivity of Stress Testing for Detecting Severe Coronary Artery Disease in Liver Transplant Candidates: A Retrospective Cohort Study.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCardiovascular disease is a leading cause of morbidity and mortality following liver transplantation. Current transplant evaluation protocols frequently rely on noninvasive stress testing to identify candidates at risk for obstructive coronary artery disease (CAD).
aimTo evaluate the diagnostic performance of cardiac stress testing for detecting severe CAD in liver transplant candidates. MATERIALS AND
methodsWe conducted a retrospective cohort study of adult patients undergoing evaluation for orthotopic liver transplantation at a tertiary transplant center. Patients underwent pre-transplant cardiac assessment with stress testing, invasive coronary angiography, or both. Severe CAD was defined as ≥70% stenosis in a major epicardial coronary artery on angiography. The diagnostic performance of stress testing was assessed in patients who underwent both modalities.
resultsAmong 637 transplant candidates, 599 (94.0%) underwent stress testing, and 240 (37.7%) underwent coronary angiography; 234 patients (36.7%) underwent both tests and were included in the diagnostic analysis. Severe CAD was identified in 26 patients (11.1%). Pharmacological stress testing demonstrated low sensitivity for detecting severe CAD (15.4%, 4/26; 95% confidence interval (CI): 4.4-34.9%) with specificity of 86.1% (179/208; 95% CI: 80.7-90.5%). The positive predictive value was 12.1% (4/33), and the negative predictive value was 89.1% (179/201). Notably, 22 of 26 patients (84.6%) with severe CAD had normal stress test results. Eleven patients (1.7%) ultimately underwent percutaneous coronary intervention (PCI), of whom 10 (90.9%) had normal stress tests, corresponding to approximately 55 stress tests performed per patient identified as requiring PCI.
conclusionIn this cohort of liver transplant candidates, stress testing demonstrated poor sensitivity for detecting severe CAD. These findings highlight critical limitations of current cardiac screening strategies and suggest that reliance on stress testing alone may result in under-detection of clinically significant CAD. Alternative approaches, including coronary computed tomography angiography (CCTA), warrant prospective evaluation for pre-transplant cardiac risk stratification.
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