Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Agrawal, Akanksha (Department of Internal Medicine, Albert Einstein Medical Center) ;
  • Jain, Deepanshu (Department of Digestive Diseases and Transplantation, Albert Einstein Medical Center) ;
  • Dias, Andre (Division of Cardiology, Department of Internal Medicine, Albert Einstein Medical Center) ;
  • Jorge, Vinicius (Department of Internal Medicine, Albert Einstein Medical Center) ;
  • Figueredo, Vincent M. (Division of Cardiology, Department of Internal Medicine, Albert Einstein Medical Center)
  • Received : 2017.11.12
  • Accepted : 2018.04.10
  • Published : 2018.09.30
⟨ Previous Next ⟩

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 $57.3{\pm}8.2years$ (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.

Keywords

References

  1. Lake JR. Changing indications for liver transplantation. Gastroenterol Clin North Am 1993;22:213-29.
  2. Donovan CL, Marcovitz PA, Punch JD, et al. Two-dimensional and dobutamine stress echocardiography in the preoperative assessment of patients with end-stage liver disease prior to orthotopic liver transplantation. Transplantation 1996;61:1180-8. https://doi.org/10.1097/00007890-199604270-00011
  3. Martin P, DiMartini A, Feng S, Brown R JrFallon M. Evaluation for liver transplantation in adults: 2013 practice guideline by the American association for the study of liver diseases and the American society of transplantation. Hepatology 2014;59:1144-65. https://doi.org/10.1002/hep.26972
  4. Lentine KL, Costa SP, Weir MR, et al. Cardiac disease evaluation and management among kidney and liver transplantation candidates: a scientific statement from the American Heart Association and the American College of Cardiology Foundation: endorsed by the American Society of Transplant Surgeons, American Society of Transplantation, and National Kidney Foundation. Circulation 2012;126:617-63. https://doi.org/10.1161/CIR.0b013e31823eb07a
  5. McCaughan GW. Trekking new ground: overcoming medical and social impediments for extended criteria liver transplant recipients. Liver Transpl 2012;18 Suppl 2:S39-46. https://doi.org/10.1002/lt.23526
  6. McAvoy NC, Kochar N, McKillop G, Newby DE, Hayes PC. Prevalence of coronary artery calcification in patients undergoing assessment for orthotopic liver transplantation. Liver Transpl 2008;14:1725-31. https://doi.org/10.1002/lt.21540
  7. Linhares MM, Azoulay D, Matos D, et al. Liver retransplantation: a model for determining long-term survival. Transplantation 2006;81:1016-21. https://doi.org/10.1097/01.tp.0000203798.96491.2f
  8. Nguyen P, Plotkin J, Fishbein TM, et al. Dobutamine stress echocardiography in patients undergoing orthotopic liver transplantation: a pooled analysis of accuracy, perioperative and long term cardiovascular prognosis. Int J Cardiovasc Imaging 2013;29:1741-8. https://doi.org/10.1007/s10554-013-0275-x
  9. Afridi I, Quinones MA, Zoghni WA, Cheirif J. Dobutamine stress echocardiography: sensitivity, specificity, and predictive value for future cardiac events. Am Heart J 1994;127:1510-5. https://doi.org/10.1016/0002-8703(94)90378-6
  10. Nicolau-Raducu R, Gitman M, Ganier D, et al. Adverse cardiac events after orthotopic liver transplantation: a cross-sectional study in 389 consecutive patients. Liver Transpl 2015;21:13-21. https://doi.org/10.1002/lt.23997
  11. Pisano G, Fracanzani AL, Caccamo L, Donato MF, Fargion S. Cardiovascular risk after orthotopic liver transplantation, a review of the literature and preliminary results of a prospective study. World J Gastroenterol 2016;22:8869-82. https://doi.org/10.3748/wjg.v22.i40.8869
  12. Pellikka PA, Oh JK, Bailey KR, Nichols BA, Monahan KH, Tajik AJ. Dynamic intraventricular obstruction during dobutamine stress echocardiography. A new observation. Circulation 1992;86:1429-32. https://doi.org/10.1161/01.CIR.86.5.1429
  13. Mazeika PK, Nadazdin A, Oakley CM. Paradoxical hypotension-bradycardia during dobutamine stress echocardiography. Circulation 1991;84:II-704.
  14. Rosamond TL, Vacek JL, Crouse U. Hypotension during dobutamine stress echocardiography: the impact of chronic beta-1 selective adrenergic antagonist therapy. Circulation 1991;84:II-477.
  15. Poldermans D, Fioretti PM, Forster T, et al. Dobutamine stress echocardiography for assessment of perioperative cardiac risk in patients undergoing major vascular surgery. Circulation 1993;87:1506-12. https://doi.org/10.1161/01.CIR.87.5.1506
  16. Tsutsui JM, Mukherjee S, Elhendy A, et al. Value of dobutamine stress myocardial contrast perfusion echocardiography in patients with advanced liver disease. Liver Transpl 2006;12:592-9. https://doi.org/10.1002/lt.20651

Cited by

  1. Cardiac Imaging in Liver Transplantation Candidates: Current Knowledge and Future Perspectives vol.8, pp.12, 2019, https://doi.org/10.3390/jcm8122132
  2. Preoperative cardiac assessment in liver transplant candidates vol.34, pp.1, 2018, https://doi.org/10.1016/j.bpa.2020.02.002