{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T22:03:25Z","timestamp":1790373805833,"version":"4.1.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","license":[{"start":{"date-parts":[[2020,10,23]],"date-time":"2020-10-23T00:00:00Z","timestamp":1603411200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,10,23]],"date-time":"2020-10-23T00:00:00Z","timestamp":1603411200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01 HL131919"],"award-info":[{"award-number":["R01 HL131919"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000070","name":"National Institute of Biomedical Imaging and Bioengineering","doi-asserted-by":"publisher","award":["5T32EB003841"],"award-info":[{"award-number":["5T32EB003841"]}],"id":[{"id":"10.13039\/100000070","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver Transpl."],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:p>\n                    We investigated the presence and severity of coronary artery disease (CAD) in orthotopic liver transplantation (OLT) candidates using coronary artery calcium score (CACS) and coronary computed tomography angiography (CCTA) as compared with the prevalence of normal and abnormal single\u2010photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). A total of 140 prospective OLT candidates without known CAD underwent coronary artery calcium (CAC) scans with (n\u00a0=\u00a077) or without CCTA and coronary computed tomography angiography\u2013derived fractional flow reserve (FFR\n                    <jats:sub>CT<\/jats:sub>\n                    ; n\u00a0=\u00a057) using a dual\u2010source computed tomography (CT) and were followed for 2.6\u00a0\u00b1\u00a01.4\u00a0years. Coronary plaque was quantified using the segment\u2010involvement score (SIS) and segment stenosis score (SSS). The mean age was 59\u00a0\u00b1\u00a06\u00a0years, and 65.0% of patients were male. Mean Agatston CACS was 367\u00a0\u00b1\u00a0653, and 15.0% of patients had CACSs of 0; 83.6% received a SPECT MPI, of which 95.7% were interpreted as normal\/probably normal. By CCTA, 9.1% had obstructive CAD (\u226570% stenosis), 67.5% had nonobstructive CAD, and 23.4% had no CAD. Nonobstructive CAD was diffuse with mean SIS 3.0\u00a0\u00b1\u00a02.9 and SSS 4.5\u00a0\u00b1\u00a05.4. Only 14 patients had high risk\u2010findings (severe 3v CAD, n\u00a0=\u00a04, CACS &gt;1000 n\u00a0=\u00a010) that prompted X\u2010ray angiography in 3 patients who had undergone CCTA, resulting in revascularization of a high\u2010risk obstruction in 1 patient who had a normal SPECT study. Patients with end\u2010stage liver disease have a high prevalence of nonobstructive CAD by CCTA, which is undiagnosed by SPECT MPI, potentially underestimating cardiovascular risk. Deferring X\u2010ray angiography unless high\u2010risk CCTA findings are present is a potential strategy for avoiding unnecessary X\u2010ray angiography.\n                  <\/jats:p>","DOI":"10.1002\/lt.25869","type":"journal-article","created":{"date-parts":[[2020,8,9]],"date-time":"2020-08-09T16:35:28Z","timestamp":1596990928000},"page":"1398-1408","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Coronary Computed Tomography Angiography Demonstrates a High Burden of Coronary Artery Disease Despite Low\u2010Risk Nuclear Studies in Pre\u2013Liver Transplant Evaluation"],"prefix":"10.1097","volume":"26","author":[{"given":"Adri\u00e1n I.","family":"L\u00f6ffler","sequence":"first","affiliation":[{"name":"Cardiovascular Division,Departments of Medicine,University of Virginia Health System,Charlottesville,VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge A.","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Cardiovascular Division,Departments of Medicine,University of Virginia Health System,Charlottesville,VA"},{"name":"Division of Cardiovascular Disease,Scripps Clinic,La Jolla,CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shriram K.","family":"Sundararaman","sequence":"additional","affiliation":[{"name":"Cardiovascular Division,Departments of Medicine,University of Virginia Health System,Charlottesville,VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roshin C.","family":"Mathew","sequence":"additional","affiliation":[{"name":"Cardiovascular Division,Departments of Medicine,University of Virginia Health System,Charlottesville,VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick T.","family":"Norton","sequence":"additional","affiliation":[{"name":"Radiology and Medical Imaging,University of Virginia Health System,Charlottesville,VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus D.","family":"Hagspiel","sequence":"additional","affiliation":[{"name":"Radiology and Medical Imaging,University of Virginia Health System,Charlottesville,VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M.","family":"Kramer","sequence":"additional","affiliation":[{"name":"Cardiovascular Division,Departments of Medicine,University of Virginia Health System,Charlottesville,VA"},{"name":"Radiology and Medical Imaging,University of Virginia Health System,Charlottesville,VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Ragosta","sequence":"additional","affiliation":[{"name":"Cardiovascular Division,Departments of Medicine,University of Virginia Health System,Charlottesville,VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Campbell","family":"Rogers","sequence":"additional","affiliation":[{"name":"HeartFlow Inc.,Redwood City,CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neeral L.","family":"Shah","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology,University of Virginia Health System,Charlottesville,VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Salerno","sequence":"additional","affiliation":[{"name":"Cardiovascular Division,Departments of Medicine,University of Virginia Health System,Charlottesville,VA"},{"name":"Radiology and Medical Imaging,University of Virginia Health System,Charlottesville,VA"},{"name":"Biomedical Engineering,University of Virginia Health System,Charlottesville,VA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,10,23]]},"reference":[{"key":"lt25869-bib-0001-20240115","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/0002-8703(60)90192-7","article-title":"The low incidence of myocardial infarction in 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Results from the prospective multicenter DISCOVER\u2010FLOW (Diagnosis of Ischemia\u2010Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study","volume":"58","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"lt25869-bib-0014-20240115","doi-asserted-by":"crossref","first-page":"3359","DOI":"10.1093\/eurheartj\/ehv444","article-title":"Clinical outcomes of fractional flow reserve by computed tomographic angiography\u2010guided diagnostic strategies vs. usual care in patients with suspected coronary artery disease: the prospective longitudinal trial of FFR(CT): outcome and resource impacts study","volume":"36","year":"2015","journal-title":"Eur Heart J"},{"key":"lt25869-bib-0015-20240115","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1053\/jhep.2001.22172","article-title":"A model to predict survival in patients with end\u2010stage liver disease","volume":"33","year":"2001","journal-title":"Hepatology"},{"key":"lt25869-bib-0016-20240115","first-page":"S49","article-title":"2013 ACC\/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines","volume":"129","year":"2014","journal-title":"Circulation"},{"key":"lt25869-bib-0017-20240115","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.jcct.2016.10.002","article-title":"SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: a report of the society of Cardiovascular Computed Tomography Guidelines Committee: Endorsed by the North American Society for Cardiovascular Imaging (NASCI)","volume":"10","year":"2016","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"lt25869-bib-0018-20240115","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1016\/0735-1097(90)90282-T","article-title":"Quantification of coronary artery calcium using ultrafast computed tomography","volume":"15","year":"1990","journal-title":"J Am Coll Cardiol"},{"key":"lt25869-bib-0019-20240115","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1161\/CIRCULATIONAHA.105.580696","article-title":"Distribution of coronary artery calcium by race, gender, and age: results from the Multi\u2010Ethnic Study of Atherosclerosis (MESA)","volume":"113","year":"2006","journal-title":"Circulation"},{"key":"lt25869-bib-0020-20240115","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.jcct.2014.07.003","article-title":"SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee","volume":"8","year":"2014","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"lt25869-bib-0021-20240115","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1016\/j.jacc.2007.03.067","article-title":"Prognostic value of multidetector coronary computed tomographic angiography for prediction of all\u2010cause mortality","volume":"50","year":"2007","journal-title":"J Am Coll Cardiol"},{"key":"lt25869-bib-0022-20240115","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1016\/j.jacc.2013.11.043","article-title":"Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of coronary blood flow using CT angiography: next steps)","volume":"63","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"lt25869-bib-0023-20240115","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.jcct.2011.06.001","article-title":"Society of cardiovascular computed tomography. 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