Dobutamine testing and post-transplant
outcomes
Title
Dobutamine stress
echocardiography in patients
undergoing liver
transplantation evaluation.
Predictive Value of
Dobutamine Stress Perfusion
Echocardiography in
Contemporary End‐Stage
Liver Disease
Utility of Dobutamine Stress
Echocardiography as Part of
the Pre-Liver Transplant
Evaluation: An Evaluation of
Its Efficacy
Year Aim/hypothesis
To assess the role of dobutamine stress
echocardiography (DSE) in these
2000
patients, DSE was included in the
preoperative evaluation.
We evaluated the predictive value of
dobutamine stress perfusion
echocardiography in 296 adult patients
with end‐stage liver disease and
preserved systolic function who
2017
underwent LT between 2008 and 2014.
The primary outcome was cardiovascular
death, nonfatal myocardial infarction,
and/or sustained ventricular arrhythmias
following LT.
We hypothesize that DSE may have
limitations in the investigation of
2014
underlying CAD in patients with end-
stage liver disease.
Results
In patients with low to moderate risk of
cardiac disease, DSE performed as part
of an evaluation for liver transplantation
is a poor predictor of major perioperative
events.
Patients with abnormal MVP during
dobutamine stress perfusion
echocardiography had a 7‐fold higher
risk of a cardiovascular event following
LT.
The study demonstrated that DSE has a
sensitivity of 41.4% (95% confidence
interval [CI]: 0.24-0.61), specificity of
47.1% (95% CI: 0.30-0.65), positive
predictive value of 40.0% (95% CI:
0.23-0.59), and negative predictive value
of 48.0% (95% CI: 0.31-0.66) in
identification of underlying CAD.
Although widely used, DSE may not
always accurately reflect the severity of
obstructive CAD in patients undergoing
OLT.
 Title
Dobutamine stress
echocardiography,
myocardial perfusion
scintigraphy, invasive
coronary angiography, and 2018
post‐liver transplantation
events: Systematic review
and meta‐analysis
Year Aim/hypothesis Results
The relative risk and confidence interval
In conclusion, this meta‐analysis found
for major adverse cardiac events were
that DSE, MPS, and ICA do not
30.2 (2.8‐325.4) for DSE, 2.6 (1.09‐6.1)
satisfactorily predict increased risk of
for MPS, and 2.1 (1.0‐2.3) for ICA, while
perioperative MACE or all‐cause
the relative risk and confidence interval
mortality among cirrhotic patients listed
for all‐cause mortality was 4.7 for DSE
for LT, among small and heterogenous
(1.8‐12.0), 2.7 (1.25‐5.9) for MPS, and
studies.
1.5 (0.89‐3.2) for ICA.

There were 29 deaths and 30 coronary

The predictors of post-
transplant coronary events
among liver transplant
recipients
Preoperative dobutamine
stress echocardiographic
findings and subsequent
short‐term adverse cardiac
events after orthotopic liver
transplantation
events over a median follow-up period of
1.75 years. Age at the time of liver
transplant was predictive of coronary
2016
event (OR 1.11, CI 1.01–1.20). The 1-year
survival in patients with a coronary event
was 47 versus 94 % in patients without a
coronary event.
..we performed a retrospective chart
review of all 284 patients that underwent
OLT at our institution between June 1999
and August 2005. Of these patients, 157
had a DSE prior to their OLT. Serious
adverse CV events occurring during
2008
surgery and up to 4 months post‐
transplantation were defined as cardiac‐
related death, myocardial infarction (MI),
new heart failure, or asystole or unstable
ventricular arrhythmia requiring acute
treatment.
In conclusion, LT recipients with cardiac
events had limited survival as compared
to the cohort without coronary events.
Identification of such patients with
noninvasive screening may provide a
practical alternative to an invasive
cardiac workup.
A multivariate model calculated from the
DSE maximum achieved heart rate
(MAHR) and MELD score (result = 3.78 +
0.07 MELD − 0.05 MAHR) identified a
47% risk for a value > 0 versus a 6% risk
for a value < 0 (P < 0.001). In conclusion,
the maximum heart rate achieved during
DSE together with the MELD score may
be a predictor of adverse CV events up
to 4 months post‐OLT.