Dobutamine stress echocardiography in patients undergoing liver transplantation evaluation. Transplantation

Department of Internal Medicine, University of Florida College of Medicine, Gainesville 32610-0277, USA.
Transplantation (Impact Factor: 3.83). 06/2000; 69(11):2354-6. DOI: 10.1097/00007890-200006150-00023
Source: PubMed


Coronary artery disease has an important impact on perioperative morbidity and mortality in patients undergoing liver transplantation. To assess the role of dobutamine stress echocardiography (DSE) in these patients, DSE was included in the preoperative evaluation.
Patients under consideration for liver transplantation underwent detailed clinical history, electrocardiography, and echocardiography. Patients with documented coronary disease or symptoms of myocardial ischemia underwent angiography. The remaining patients with cardiac risk factors, atypical chest pain, or age > or = 60 years underwent DSE.
These 121 patients (77 men and 44 women) ranged in age from 34 to 73 years (mean 53). Among the 61 patients who underwent liver transplantation, DSE was normal in 25, nondiagnostic in 34 because of inadequate heart rate response, and abnormal in two patients. Major perioperative events occurred in eight patients, all with normal or nondiagnostic DSE studies (negative predictive value 86%).
In patients with low to moderate risk of cardiac disease, DSE performed as part of an evaluation for liver transplantation is a poor predictor of major perioperative events.

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    • "The American Association for the Study of Liver Diseases (AASLD) recommends that LT candidates who are older than 50, diabetic, past or present smokers, or have a family history of heart disease undergo a cardiac stress test (dobutamine stress echo (DSE), pharmacologic nuclear perfusion) or cardiac catheterization to rule out obstructive coronary artery disease (CAD) [2]. However, the data to support this recommendation is controversial [3] [4] [5] [6] and whether this strategy is effective in reducing cardiac events following LT has not been proven. In addition current evidence [7] [8] [9], including our own experience [10], suggests that serious postcardiac arrhythmias at the time of donor liver reperfusion and in the postoperative period are also a major cause of cardiac events following LT. "
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    ABSTRACT: Objectives. To determine the importance of acute cardiac events as a cause of mortality compared to non-cardiac events in the four month period following liver transplantation (LT) using current preoperative cardiac screening strategies. Patients and Methods. We retrospectively reviewed timing, type, and outcome of adverse cardiac events, and all cause mortality in the 4 month postoperative period in 393 consecutive LT patients from October 1999 to February 2008. Results. Of 30 total deaths (7.6% overall mortality rate), 27 (90%) were due to surgical or medical complications and 3 (10%) were primary cardiac deaths (0.8% cardiac mortality rate). Acute cardiac events occurred in 26 patients (6.6%), including 13 arrhythmias (50%), 7 new onset heart failures (27%), and 6 myocardial infarctions (23%). Twelve of 13 intraoperative events were arrhythmias (92%) including two of three cardiac deaths. Conclusions. Using current preoperative screening recommendations, deaths from primary cardiac events within four months of LT are very uncommon (0.8%), especially compared with deaths related to medical and surgical complications (6.9%).
    Journal of Transplantation 08/2010; 2010. DOI:10.1155/2010/910165
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    ABSTRACT: 1. vyd.
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    Transplantation 04/2001; 71(6):818. DOI:10.1097/00007890-200103270-00023 · 3.83 Impact Factor
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