Predictive Value of Dobutamine Stress Echocardiography for Coronary Artery Disease Detection in Liver Transplant Candidates

Abstract

Patients with obstructive coronary artery disease (CAD) undergoing orthotopic liver transplantation (OLT) are at increased risk of poor outcomes. The accuracy of dobutamine stress echocardiography (DSE) to detect obstructive CAD is not well established in this population. We retrospectively identified patients with end-stage liver disease who underwent both DSE and coronary angiography as part of risk stratification prior to OLT. One hundred and five patients had both DSE and angiography, of whom 14 had known CAD and 27 failed to reach target heart rate during DSE. Among the remaining 64 patients (45 men; average age 61 ± 8 years) DSE had a low sensitivity (13%), high specificity (85%), low positive predictive value (PPV) (22%) and intermediate negative predictive value (NPV) (75%) for obstructive CAD. DSE as a screening test for obstructive CAD in OLT candidates has a poor sensitivity. The frequent chronotropic incompetence and low sensitivity in patients who achieve target heart rate, even in those with multiple cardiovascular disease risk factors, suggest that alternative or additional methods of risk stratification are necessary.

Accuracy of Stress Myocardial Perfusion Imaging to Diagnose Coronary Artery Disease in End Stage Liver Disease Patients

“…Results with dobutamine stress echocardiography have shown poor sensitivity and low negative predictive value, partially because of an inability to reach target heart rate. 2,12,13 Most of these patients are on b blockers to decrease portal hypertension and prevent esophageal bleeding. Ideally, a noninvasive test should be highly sensitive to diagnose CAD in potential transplantation patients, considering the perioperative cardiovascular complication risks involved with the surgery.…”

Chronotropic Incompetence on Dobutamine Stress Echocardiography in Candidates for a Liver Transplant

“…Similar to the definition of exercise-induced cardiac stress testing, chronotropic incompetence was defined as the inability to reach 85% of the predicted maximal HR for age and sex at the maximum dosage of dobutamine (40 μg/kg/min). 8 Ischemic endpoints including chest pain, segment depression > 2 mm, new or worsened wall-motion abnormalities, dysrhythmias, significant blood pressure changes (blood pressure > 240/120 mm Hg or decline in systolic blood pressure > 40 mm Hg), or any intolerable symptoms led to early termination of the stress test. We did not compare the clinical and hemodynamic characteristics among patients who achieved their target heart rate (THR) with those who did not.…”

“…[20][21][22] Earlier studies evaluating the DSE as a screening technique for obstructive coronary artery disease in ESLD patients have yielded conflicting results. [7][8][9][10][11] Plotkin and associates concluded that the DSE has sensitivity, specificity, and positive and negative predictive values of 100% 9 ; however, Harinstein and associates reported that the DSE has a poor sensitivity as a screening test for obstructive coronary artery disease in LT candidates and recommend alternate or additional methods for adequate cardiac risk stratification. 2,8 limitations This is a retrospective study based on chart reviews and has a low event rate; therefore, drawing statistical conclusions may be difficult.…”

“…Although various studies have produced conflicting results about the predictive value of DSE in these patients. [7][8][9][10][11] This study sought to determine the prevalence and causes of chronotropic incompetence in patients with ESLD, and to examine the adequacy of our current DSE protocol in predicting cardiac events after an LT.…”

Ocena kardiologiczna pacjentów z niewydolnością wątroby w ramach kwalifikacji do operacji przeszczepienia wątroby

“…Brak wzrostu LVEF o 10% względem wartości spoczynkowych podczas próby dobutaminowej świadczy o nieprawidłowej odpowiedzi skurczowej na obciążenie i w przypadku pacjentów z marskością wątroby może wynikać z CCM, pod warunkiem braku innej choroby układu sercowo-naczyniowego [6]. Ze względu na zróżnicowaną etiologię zmniejszonej rezerwy kurczliwości testy obciążeniowe w tej grupie chorych mają obniżoną wartość diagnostyczną w ocenie niedokrwienia mięśnia sercowego [7].…”