Real World Utility of Dobutamine Stress Echocardiography in Predicting Perioperative Cardiovascular Morbidity and Mortality after Orthotopic Liver Transplantation

Akanksha Agrawal; Deepanshu Jain; Andre Dias; Vinicius Jorge; Vincent M. Figueredo

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자료유형: 학술저널

저자정보: Akanksha Agrawal (Albert Einstein Medical Center) Deepanshu Jain (Albert Einstein Medical Center) Andre Dias (Albert Einstein Medical Center) Vinicius Jorge (Albert Einstein Medical Center) Vincent M. Figueredo (Albert Einstein Medical Center)

저널정보: 대한심장학회 Korean Circulation Journal Korean Circulation Journal Vol.48 No.9

발행연도: 2018.1

수록면: 828 - 835 (8page)

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Background and Objectives Stress echocardiography is the current standard for cardiac risk stratification of patients undergoing orthotopic liver transplantation (OLT). We aim to evaluate the role of dobutamine stress echocardiography (DSE) in predicting perioperative major adverse cardiac event (MACE) in patients undergoing OLT. Methods This was a single-center retrospective study including 144 OLT patients. Of 144 patients, 118 had DSE. MACE included myocardial infarction (MI), heart failure (HF), cardiovascular and all-cause death 1 year after OLT. Results Our study cohort included 118 patients. The mean age was 57.3±8.2 years (range, 25–72 years). There were 85 men and 33 women, male to female ratio being 2.6:1. Of 118, 15 (13%) had positive DSE and 103 (87%) had negative DSE. Perioperative MACE incidence was 5.9% (95% confidence interval [CI], 2.6–12.3%). In predicting MACE, DSE had sensitivity of 5.6% (95% CI, 0.2–29.4%), specificity 86% (95% CI, 77.3–91.9%), positive predictive value 6.7% (95% CI, 0.3–33.4%), and negative predictive value (NPV) 83.5% (95% CI, 74.6–89.8%). Eighteen patients had MACE in first year post OLT (15%, 95% CI, 9.5–23.3%). Adverse events included cardiogenic shock (2/18), systolic HF (2/18), non-ST-elevated MI (7/18), cardiac mortality (3/18), and all-cause mortality (7/18). The overall complication rate of DSE was 17% (20/118). Conclusions In our cohort, DSE had a low sensitivity but high NPV in predicting perioperative MACE post OLT. A similar trend was noted for DSE in predicting 1-year MACE post OLT. We reiterate the need of a better screening and risk stratification tool for OLT.

참고문헌 (16)

참고문헌 신청

Lake JR / 1993 / Changing indications for liver transplantation / Gastroenterol Clin North Am 22:213~229

Donovan CL / 1996 / Two-dimensional and dobutamine stress echocardiography in the preoperative assessment of patients with end-stage liver disease prior to orthotopic liver transplantation / Transplantation 61:1180~1188

Martin P / 2014 / Evaluation for liver transplantation in adults: 2013 practice guideline by the American association for the study of liver diseases and the American society of transplantation / Hepatology 59:1144~1165

Lentine KL / 2012 / 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: endorsed by the American Society of Transplant Surgeons, American Society of Transplantation, and National Kidney Foundation / Circulation 126:617~663

McCaughan GW / 2012 / Trekking new ground: overcoming medical and social impediments for extended criteria liver transplant recipients / Liver Transpl 18(Suppl 2):S39~S46

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