CONGRESS ABSTRACT

Obstructive coronary artery disease (CAD) remains a major concern in liver transplant candidates, yet non-invasive predictive models for its assessment are lacking. As a result, many candidates undergo unnecessary coronary angiographies (CAG), often revealing no significant coronary lesions, which result in expensive investigations that delays or complicates the transplant process. This study aimed to analyze the role of the Coronary Artery Calcium Score (CAC-S) as a tool for better cardiovascular (CV) risk stratification in this population. Of 239 patients evaluated at the Liver Disease Unit of the POIT, San Camillo Forlanini Hospital, 151 underwent Cardiac-CT for CAC-S assessment based on age and CV risk profile. Of these, on the basis of CAC-S values and the number of coronary arteries involved, 71 underwent CAG and 17 underwent revascularization via PCI or CABG. All patients underwent transthoracic echocardiography and, when cirrhotic cardiomyopathy was suspected, cardiac MRI was performed. Patients were grouped based on CAC-S (<400 and ≥400 AU) to compare clinical variables. Individuals with elevated CAC-S were slightly older (60 vs. 59 years, p=0.036) and more likely to have a history of CAD (10 vs. 2 patients, p=0.02). Cirrhosis etiology was significantly associated with CAC-S: alcohol-related cirrhosis showed higher scores (p=0.004), while viral cirrhosis and metabolic dysfunction–associated steatosic liver disease (MASLD) did not. CAC-S ≥400 AU were also linked to increased LGE areas on cardiac MRI (7 vs. 3 patients, p=0.037), suggesting microvascular damage. A ROC analysis identified a CAC-S cut-off of 496 AU for predicting obstructive CAD in the overall cohort (AUC=0.8), but its lack of statistical significance (p=0.48) limited clinical utility. Etiology-specific cut-offs improved accuracy: 150 AU for MASLD (AUC=0.79,p=0.05), 234 AU for viral hepatitis (AUC=0.877, p=0.003), and 696 AU for alcohol-related cirrhosis (AUC=0.733, p=0.005). This study underscores the need for non-invasive, etiology-specific tools to minimize avoidable invasive testing in liver transplant candidates. Stratifying CAC-S cut-offs by cirrhosis etiology offers a practical and personalized approach to risk assessment, potentially streamlining the transplant process and reducing delays due to unnecessary CAG. While limited by sample selection and population homogeneity, these findings pave the way for more efficient and targeted CV evaluation in this high-risk cohort.