Dobutamine stress echocardiography in patients undergoing liver transplantation evaluation

Background. Coronary artery disease has an important impact on perioperative morbidity and mortality in patients undergoing liver transplantation. To assess the role of dobutamine stress echocardiography (DSE) in these patients, DSE was included in the preoperative evaluation. Methods. Patients under consideration for liver transplantation underwent detailed clinical history, electrocardiography, and echocardiography, Patients with documented coronary disease or symptoms of myocardial ischemia underwent angiography, The remaining patients with cardiac risk factors, atypical chest pain, or age greater than or equal to 60 years underwent DSE, Results. These 121 patients (77 men and 44 women) ranged in age from 34 to 73 years (mean 53), Among the 61 patients who underwent liver transplantation, DSE was normal in 25, nondiagnostic in 34 because of inadequate heart rate response, and abnormal in two patients. Major perioperative events occurred in eight patients, all with normal or nondiagnostic DSE studies (negative predictive value 86%). Conclusions. 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.