Korean Circ J.  2018 Sep;48(9):828-835. 10.4070/kcj.2017.0350.

Real World Utility of Dobutamine Stress Echocardiography in Predicting Perioperative Cardiovascular Morbidity and Mortality after Orthotopic Liver Transplantation

• Agrawal A
• Jain D
• Dias A
• Jorge V
• Figueredo

• KMID: 2418808
• DOI: http://doi.org/10.4070/kcj.2017.0350

Abstract

BACKGROUND AND OBJECTIVES
Stress echocardiography is the current standard for cardiac risk stratification of patients undergoing orthotopic liver transplantation (OLT). We aim to evaluate the role of dobutamine stress echocardiography (DSE) in predicting perioperative major adverse cardiac event (MACE) in patients undergoing OLT.
METHODS
This was a single-center retrospective study including 144 OLT patients. Of 144 patients, 118 had DSE. MACE included myocardial infarction (MI), heart failure (HF), cardiovascular and all-cause death 1 year after OLT.
RESULTS
Our study cohort included 118 patients. The mean age was 57.3±8.2 years (range, 25-72 years). There were 85 men and 33 women, male to female ratio being 2.6:1. Of 118, 15 (13%) had positive DSE and 103 (87%) had negative DSE. Perioperative MACE incidence was 5.9% (95% confidence interval [CI], 2.6-12.3%). In predicting MACE, DSE had sensitivity of 5.6% (95% CI, 0.2-29.4%), specificity 86% (95% CI, 77.3-91.9%), positive predictive value 6.7% (95% CI, 0.3-33.4%), and negative predictive value (NPV) 83.5% (95% CI, 74.6-89.8%). Eighteen patients had MACE in first year post OLT (15%, 95% CI, 9.5-23.3%). Adverse events included cardiogenic shock (2/18), systolic HF (2/18), non-ST-elevated MI (7/18), cardiac mortality (3/18), and all-cause mortality (7/18). The overall complication rate of DSE was 17% (20/118).
CONCLUSIONS
In our cohort, DSE had a low sensitivity but high NPV in predicting perioperative MACE post OLT. A similar trend was noted for DSE in predicting 1-year MACE post OLT. We reiterate the need of a better screening and risk stratification tool for OLT.

Keyword

Dobutamine stress echocardiography; Liver transplantation; Major adverse cardiac event; Coronary artery disease

MeSH Terms

Cohort Studies
Coronary Artery Disease
Dobutamine*
Echocardiography, Stress*
Female
Heart Failure
Humans
Incidence
Liver Transplantation*
Liver*
Male
Mass Screening
Mortality*
Myocardial Infarction
Retrospective Studies
Sensitivity and Specificity
Shock, Cardiogenic
Dobutamine

Figure

• 

  Figure 1 Flowchart depicting the number of patients who underwent DSE and LHC. DSE = dobutamine stress echocardiography; LHC = left heart catheterization; OLT = orthotopic liver transplantation.

• 

  Figure 2 Distribution of MACE across time. CHF = congestive heart failure; MACE = major adverse cardiac event; NSTEMI = non-ST-elevated myocardial Infarction; POD = post-operative day.

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