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Reviews in Cardiovascular Medicine  2017, Vol. 18 Issue (4): 146-154     DOI: 10.3909/ricm0892
Review Previous articles |
Utility of Dobutamine Stress Echocardiography in Cardiac Risk Stratification of Patients Undergoing Orthotopic Liver Transplantation
Akanksha Agrawal1, Deepanshu Jain2, Eyob L. Feyssa2, Aman M. Amanullah3
1 Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA
2 Department of Digestive Diseases and Transplantation, Albert Einstein Medical Center, Philadelphia, PA
3 Division of Cardiology, Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA
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Abstract:
Cardiovascular diseases are a major cause of morbidity and mortality in patients after orthotopic liver transplantation (OLT). This review includes major original articles published in the English-language literature of patients who underwent dobutamine stress echocardiography (DSE) before OLT for cardiac risk stratification. Of a total of 10 original articles (total 1699 patients undergoing DSE), 6 studies used DSE to predict major adverse cardiac events (MACE) in patients undergoing OLT and 4 reported the role of DSE in coronary artery disease (CAD) prediction in patients with end-stage liver disease. The composite incidence of MACE was 11.4%. In predicting postoperative MACE, DSE had a composite sensitivity of 0.12 (95% CI, 0.07-0.19), a specificity of 0.96 (95% CI, 0.94-0.97), a positive predictive value (PPV) of 0.26 (95% CI, 0.16-0.38), and a negative predictive value (NPV) of 0.89 (95% CI, 0.88-0.91). The presence of known CAD in a patient was shown to increase the risk of cardiac events after OLT significantly in three of six studies. The average prevalence of CAD was 14.4%. In predicting CAD, DSE had a composite sensitivity of 0.47 (95% CI, 0.32-0.62), specificity of 0.74 (95% CI, 0.68- 0.79), PPV of 0.23 (95% CI, 0.15-0.33), and NPV of 0.89 (95% CI, 0.84-0.93). This review emphasizes the need for standardizing cardiac risk stratification protocol to screen and prevent cardiac morbidity after OLT, standardizing MACE definition to allow more uniform reporting, and the need for safer and efficacious alternatives to DSE in the evaluation of OLT candidates.
Key words:  Dobutamine stress echocardiography      Cardiovascular event      Liver transplantation      Coronary artery disease     

Cite this article: 

Akanksha Agrawal, Deepanshu Jain, Eyob L. Feyssa, Aman M. Amanullah. Utility of Dobutamine Stress Echocardiography in Cardiac Risk Stratification of Patients Undergoing Orthotopic Liver Transplantation. Reviews in Cardiovascular Medicine, 2017, 18(4): 146-154.

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https://rcm.imrpress.com/EN/10.3909/ricm0892     OR     https://rcm.imrpress.com/EN/Y2017/V18/I4/146

1. Transplant trends. United Network for Organ Sharing website. https://www.unos.org/data/transplanttrends/# transplants_by_organ_type+year+2016. Accessed December 12, 2017.
2. Futagawa Y, Terasaki PI, Waki K, et al. No improvement in long-term liver transplant graft survival in the last decade: an analysis of the UNOS data. Am J Transplant. 2006;6:1398-1406.
3. VanWanger LB, Lapin B, Levitsky J, et al. High early cardiovascular mortality after liver transplantation. Liver Transpl. 2014;20:1306-1316.
4. Watt KD, Pedersen RA, Kremers WK, et al. Evolution of causes and risk factors for mortality post-liver transplant: results of the NIDDK long-term follow-up study. Am J Transplant. 2010;10:1420-1427.
5. 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;61:1180-1188.
6. Martin P, DiMartini A, Feng S, et al. Evaluation for liver transplantation in adults: 2013 practice guideline by the AASLD and the American Society of Transplantation. Hepatology. 2014;59:1144-1165.
7. Baibhav B, Mahabir CA, Xie F, et al. Predictive value of dobutamine stress perfusion echocardiography in contemporary end-stage liver disease. J Am Heart Assoc. 2017;6:e005102.
8. Safadi A, Homsi M, Maskoun W, et al. Perioperative risk predictors of cardiac outcomes in patients undergoing liver transplantation surgery. Circulation. 2009;120:1189-1194.
9. 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.
10. Umphrey LG, Hurst RT, Eleid MF, et al. Preoperative dobutamine stress echocardiographic findings and subsequent short-term cardiac events after orthotopic liver transplantation. Liver Transpl. 2008;14:886-892.
11. Findlay JY, Keegan MT, Pellikka PP, et al. Preoperative dobutamine stress echocardiography, intraoperative events, and intraoperative myocardial injury in liver transplantation. Tranplant Proc. 2005;37:2209- 2213.
12. Williams K, Lewis J, Davis G, Geiser E. Dobutamine stress echocardiography in patients undergoing liver transplantation evaluation. Trasplantation. 2000;69:2354-2356.
13. Snipelisky D, Ray J, Vallabhajosyula S, et al. Usefulness for predicting cardiac events after orthotopic liver transplantation of myocardial perfusion imaging and dobutamine stress echocardiography preoperatively. Am J Cardiol. 2017;119:1008-1011.
14. Plotkin JS, Benitez RM, Kuo PC, et al. Dobutamine stress echocardiography for preoperative cardiac risk stratification in patients undergoing orthotopic liver transplantation. Liver Transpl Surg. 1998;4:253-257.
15. Harinstein ME, Flaherty JD, Ansari AH, et al. Predictive value of dobutamine stress echocardiography for coronary artery disease detection in liver transplant candidates. Am J Transplant. 2008;8:1523-1528.
16. Patel S, Kiefer TL, Ahmed A, et al. Comparison of the frequency of coronary artery disease in alcohol-related versus non-alcohol-related endstage liver disease. Am J Cardiol. 2011;108:1552-1555.
17. 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. Circulation. 2012;126:617-663.
18. Konerman MA, Fritze D, Weinberg RL, et al. Incidence of and risk assessment for adverse cardiovascular outcomes after liver transplantation: a systematic review. Transplantation. 2017;101:1645-1657.
19. Aydinalp A, Bal U, Atar I, et al. Value of stress myocardial perfusion scanning in diagnosis of severe coronary artery disease in liver transplantation candidates. Transplant Proc. 2009;41:3757-3760.
20. 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;592-599.
21. Centers for Disease Control and Prevention. Prevalence of coronary heart disease--United States, 2006- 2010. MMWR Morb Mortal Wkly Rep. 2011;60:1377- 1381.
22. Carey WD, Dumot JA, Pimentel RR, et al. The prevalence of coronary artery disease in liver transplant candidates over age 50. Transplantation. 1995;59: 859-864.
23. Pisano G, Fracanzani AL, Caccamo L, et al. Cardiovascular risk after orthotopic liver transplantation: a review of the literature and preliminary results of a prospective study. World J Gastroenterol. 2016;22:8869-8882.
24. Peliikka PA, Oh JK, Bailey KR, et al. Dynamic intraventricular obstruction during dobutamine stress echocardiography: a new observation. Circulation. 1992;86:1429-1432.
25. Mazeika PK, Nadazdin A, Oakley CM. Paradoxical hypotension- bradycardia during dobutamine stress echocardiography. Circulation. 1991;84(suppl II):II-704.
26. Rosamond TL, Vacek JL, Crouse U. Hypotension during dobutamine stress echocardiography: the impact of chronic beta-1 selective adrenergic antagonist therapy. Circulation. 1991;84(suppl II):II-477.
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