Usefulness of preoperative stress perfusion imaging in predicting prognosis after liver transplantation

Zoghbi, Gilbert J.; Patel, Amar D.; Ershadi, Reza; Heo, Jaekyeong; Bynon, John S.; Iskandrian, Ami E.

doi:10.1016/j.amjcard.2003.06.003

Cited by 70 publications

(40 citation statements)

References 21 publications

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“…It is noteworthy to point out that early mortality outcomes after LTS are usually due to infection or allograft failure and are not cardiovascular in nature. 6 In fact, shortterm perioperative outcomes for both MI and cardiac death were found to be Ͻ3% in 1 study. 6 Zoghbi et al 6 pointed out that late cardiovascular-related mortality is often seen in patients with a history of CAD or known risk factors, with a reported mortality of 16% to 22% within 5 years of transplantation.…”

Section: Discussionmentioning

confidence: 89%

“…Compared with other transplantation surgeries, liver transplantation can induce marked perioperative hemodynamic and hypercoagulability alterations that can adversely affect outcomes in patients with known CAD. 6 Therefore, we sought to identify prognostic markers and perioperative risk for cardiac outcomes in patients undergoing LTS to better assist in risk stratification of this population. Of note, nonfatal MI was defined through the use of troponin positivity.…”

Section: Discussionmentioning

confidence: 99%

“…5 In 1 study, stress echocardiography did not reliably identify patients at high cardiac risk during liver transplantation; another showed that a normal stress myocardial perfusion study identified patients at very low risk for early and late cardiac events despite having high-risk profiles. 5,6 Defining risk in this population remains challenging with no optimal cardiovascular risk stratification strategy available. 7 Lester et al 7 reported that there are no formal guidelines to help in this process, but generally, patients who are Ͼ45 years of age or who have history of diabetes mellitus, peripheral vascular disease, or Ͼ2 standard cardiac risk factors should undergo some type of formal cardiovascular testing.…”

Section: Clinical Perspective On P 1194mentioning

confidence: 99%

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Perioperative Risk Predictors of Cardiac Outcomes in Patients Undergoing Liver Transplantation Surgery

et al. 2009

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Clinical Perspective On P 1194mentioning

confidence: 99%

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Perioperative Risk Predictors of Cardiac Outcomes in Patients Undergoing Liver Transplantation Surgery

et al. 2009

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“…Dobutamine stress echocardiography was done in accordance with the American Association for Study of Liver Diseases guidelines for patients ≥ 50 years old who have a history of chronic smoking or risk factors for cardiac disease. 14,15 Patients with right ventricular systolic pressure > 35 mm Hg on echocardiogram at our center underwent right heart catheterization for measurement of mean pulmonary arterial pressure. Patients with established coronary artery disease or with abnormal dobutamine stress echocardiography underwent left heart catheterization for coronary arterial patency.…”

Section: Data Collectionmentioning

confidence: 99%

Untitled

Piazza

Singal²

2016

Exp Clin Transplant

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Objectives: Frequency of liver transplants because of nonalcoholic steatohepatitis is increasing. Data are conflicting on nonalcoholic steatohepatitis as a risk factor for cardiovascular events after transplant. Materials and Methods:We reviewed medical records of liver transplant recipients (between years 2005 and 2010) for alcoholic cirrhosis or nonalcoholic steatohepatitis for cardiovascular events (arrhythmia, congestive heart failure, coronary disease, pulmonary hypertension, or stroke) and patient survival within 3 years. Results: Compared with the 65 transplant recipients for alcoholic cirrhosis, the 78 transplant recipients for nonalcoholic steatohepatitis were significantly (P < .0001 for all) more likely to be female (46% vs 8%), have a larger mean body mass index (34 ± 7 vs 29 ± 5), more likely to have diabetes (58% vs 26%), less likely to be hepatitis C virus-positive (3% vs 29%), and less likely to smoke (29% vs 69%). Eleven patients with nonalcoholic steatohepatitis and 9 patients with nonalcoholic steatohepatitis had cardiovascular events; however, these groups were not significantly different 1 year (7.7% vs 6.1%; P = .45) or 3 years (14.1% vs 13.8%; P = .9) after liver transplant. The odds of having a cardiovascular event were about 9-fold greater for patients with concomitant hepatitis C virus and 3-fold greater for men. Eighteen patients died, with patients with cardiovascular events having greater than 4-fold increased mortality (mean 4.1-fold; range, 1.2-fold to 13.9-fold). Conclusions: Cardiovascular events occurred with similar frequency in transplant recipients for nonalcoholic steatohepatitis or alcoholic cirrhosis. Patient survival was affected in both groups, but male patients with concomitant hepatitis C virus infection remained at higher risk for a cardiovascular event after liver transplant. Development of a cardiac evaluation protocol for liver transplant recipients could help monitor these patients.

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“…Ischemia tests (myocardial scintigraphy and dobutamine echocardiography) have proven to be useful in several studies to assess the candidate for liver transplantation 117,[122][123][124] . When associated with physical exercise protocols, both tests have similar sensitivity and specificity.…”

Section: Livermentioning

confidence: 99%