Usefulness for Predicting Cardiac Events After Orthotopic Liver Transplantation of Myocardial Perfusion Imaging and Dobutamine Stress Echocardiography Preoperatively

• Published in: The American journal of cardiology Vol. 119; no. 7; pp. 1008 - 1011
• Main Authors: Snipelisky, David, MD, Ray, Jordan, MD, Vallabhajosyula, Saraschandra, MBBS, Matcha, Gautam, MD, Squier, Samuel, MD, Lewis, Jacob, MD, Holliday, Rex, MD, Aggarwal, Niti, MD, Askew, J. Wells, MD, Shapiro, Brian, MD, Anavekar, Nandan, MBBCh
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2017; Elsevier Limited
• Subjects: Acute coronary syndromes; Cardiovascular; Cardiovascular disease; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - epidemiology; Coronary vessels; Dobutamine; Echocardiography, Stress; Female; Florida - epidemiology; Heart rate; Hepatitis; Humans; Liver diseases; Liver Transplantation; Male; Middle Aged; Minnesota - epidemiology; Mortality; Myocardial Perfusion Imaging; Patients; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Predictive Value of Tests; Preoperative Care; Retrospective Studies; Risk Factors; Transplants & implants; end-stage liver disease; dobutamine stress echocardiography; pre liver transplant evaluation; nuclear perfusion imaging
• DOI: 10.1016/j.amjcard.2016.11.060
• ISSN: 0002-9149

Abstract Patients undergoing orthotopic liver transplantation (OLT) have high rates of cardiac morbidity and mortality. Although guidelines recommend non-invasive stress testing as part of the preoperative evaluation, little data have evaluated clinical outcomes following OLT. A retrospective study at two high volume liver transplantation centers was performed. All patients undergoing non-invasive stress testing (myocardial perfusion imaging [MPI] or dobutamine stress echocardiography [DSE]) over a 5-year period were included. Descriptive analyses, including clinical outcomes and peri- and post- operative ischemic events, were performed. Comparisons were made between subsets of patients within each stress modality based on abnormal versus normal results. A total of 506 patients were included, of which 343 underwent DSE and 163 MPI. Few patients had abnormal results, with 19 (5.5%) in the DSE group and 13 (8%) in the MPI group. Peri- and post-operative cardiac complications were low (n=20, 5.8% and n=3, 0.9% in DSE group and n=15, 9.2% and n=3, 1.8% in MPI group). Comparisons between abnormal versus normal findings showed a trend toward peri-procedural cardiac complications in the abnormal DSE group (n=3, 15.8% versus n=17, 5.25%; p=0.09) with no difference in 6-month post-procedural complications (n=0 versus n=3, 0.9%; p=1.0). In the MPI group, a trend toward peri-procedural ischemic complications (n=3, 23.1% versus n=12, 8%; p=0.1) was noted with no difference in 6-month post-procedural complications (n=0 versus n=3, 2%; p=1.0). In conclusion, our study found a significantly lower than reported cardiac event rate. Additionally, it demonstrated that ischemic cardiac events are uncommon in patients with normal stress testing.