Predictive value of dobutamine stress perfusion echocardiography in contemporary end-stage liver disease

Bipul Baibhav, Chetaj A. Mahabir, Feng Xie, Valerie K. Shostrom, Timothy M McCashland, Thomas Richard Porter

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background-The assessment of cardiac risk in contemporary liver transplantation (LT) has required more sensitive testing for the detection of occult coronary artery disease as well as microvascular and functional cardiac abnormalities. Because dobutamine stress perfusion echocardiography provides an assessment of both regional systolic and diastolic function as well as microvascular perfusion (MVP), we sought to examine its incremental value in this setting. Methods and Results-We evaluated the predictive value of dobutamine stress perfusion echocardiography in 296 adult patients with end-stage liver disease and preserved systolic function who underwent LT between 2008 and 2014. The primary outcome was cardiovascular death, nonfatal myocardial infarction, and/or sustained ventricular arrhythmias following LT. The main causes of liver failure were hepatitis C (25%) and nonalcoholic fatty liver disease (13%). Abnormal MVP during stress was observed in 18 patients (6%), whereas diastolic dysfunction was present in 109 patients (94 grade 1, 15 grade 2). Half of the patients (7 of 14) referred for angiography with abnormal MVP had significant epicardial disease by angiography, and these patients were revascularized prior to LT. Despite these interventions, the primary outcome still occurred in 9 patients (3%). Patients with abnormal MVP during dobutamine stress perfusion echocardiography had a 7-fold higher risk of a cardiovascular event following LT. Cox proportional hazards modeling examining clinical variables, left ventricular ejection fraction, diastolic function, and stressinduced wall motion abnormalities or MVP defects demonstrated that abnormal MVP was the only independent predictor of the primary outcome (P=0.004; hazard ratio 7.7). Conclusions-Stress MVP assessments are highly predictive of cardiovascular outcome in current LT candidates.

Original languageEnglish (US)
Article numbere005102
JournalJournal of the American Heart Association
Volume6
Issue number2
DOIs
StatePublished - Jan 1 2017

Fingerprint

Stress Echocardiography
End Stage Liver Disease
Perfusion
Liver Transplantation
Angiography
Liver Failure
Hepatitis C
Stroke Volume
Cardiac Arrhythmias
Coronary Artery Disease
Myocardial Infarction

Keywords

  • Coronary artery disease
  • Left ventricular ejection fraction
  • Liver transplantation
  • Microvascular dysfunction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Predictive value of dobutamine stress perfusion echocardiography in contemporary end-stage liver disease. / Baibhav, Bipul; Mahabir, Chetaj A.; Xie, Feng; Shostrom, Valerie K.; McCashland, Timothy M; Porter, Thomas Richard.

In: Journal of the American Heart Association, Vol. 6, No. 2, e005102, 01.01.2017.

Research output: Contribution to journalArticle

@article{9bddc1a24d0d4c8e97438521a0c7733a,
title = "Predictive value of dobutamine stress perfusion echocardiography in contemporary end-stage liver disease",
abstract = "Background-The assessment of cardiac risk in contemporary liver transplantation (LT) has required more sensitive testing for the detection of occult coronary artery disease as well as microvascular and functional cardiac abnormalities. Because dobutamine stress perfusion echocardiography provides an assessment of both regional systolic and diastolic function as well as microvascular perfusion (MVP), we sought to examine its incremental value in this setting. Methods and Results-We evaluated the predictive value of dobutamine stress perfusion echocardiography in 296 adult patients with end-stage liver disease and preserved systolic function who underwent LT between 2008 and 2014. The primary outcome was cardiovascular death, nonfatal myocardial infarction, and/or sustained ventricular arrhythmias following LT. The main causes of liver failure were hepatitis C (25{\%}) and nonalcoholic fatty liver disease (13{\%}). Abnormal MVP during stress was observed in 18 patients (6{\%}), whereas diastolic dysfunction was present in 109 patients (94 grade 1, 15 grade 2). Half of the patients (7 of 14) referred for angiography with abnormal MVP had significant epicardial disease by angiography, and these patients were revascularized prior to LT. Despite these interventions, the primary outcome still occurred in 9 patients (3{\%}). Patients with abnormal MVP during dobutamine stress perfusion echocardiography had a 7-fold higher risk of a cardiovascular event following LT. Cox proportional hazards modeling examining clinical variables, left ventricular ejection fraction, diastolic function, and stressinduced wall motion abnormalities or MVP defects demonstrated that abnormal MVP was the only independent predictor of the primary outcome (P=0.004; hazard ratio 7.7). Conclusions-Stress MVP assessments are highly predictive of cardiovascular outcome in current LT candidates.",
keywords = "Coronary artery disease, Left ventricular ejection fraction, Liver transplantation, Microvascular dysfunction",
author = "Bipul Baibhav and Mahabir, {Chetaj A.} and Feng Xie and Shostrom, {Valerie K.} and McCashland, {Timothy M} and Porter, {Thomas Richard}",
year = "2017",
month = "1",
day = "1",
doi = "10.1161/JAHA.116.005102",
language = "English (US)",
volume = "6",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Predictive value of dobutamine stress perfusion echocardiography in contemporary end-stage liver disease

AU - Baibhav, Bipul

AU - Mahabir, Chetaj A.

AU - Xie, Feng

AU - Shostrom, Valerie K.

AU - McCashland, Timothy M

AU - Porter, Thomas Richard

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background-The assessment of cardiac risk in contemporary liver transplantation (LT) has required more sensitive testing for the detection of occult coronary artery disease as well as microvascular and functional cardiac abnormalities. Because dobutamine stress perfusion echocardiography provides an assessment of both regional systolic and diastolic function as well as microvascular perfusion (MVP), we sought to examine its incremental value in this setting. Methods and Results-We evaluated the predictive value of dobutamine stress perfusion echocardiography in 296 adult patients with end-stage liver disease and preserved systolic function who underwent LT between 2008 and 2014. The primary outcome was cardiovascular death, nonfatal myocardial infarction, and/or sustained ventricular arrhythmias following LT. The main causes of liver failure were hepatitis C (25%) and nonalcoholic fatty liver disease (13%). Abnormal MVP during stress was observed in 18 patients (6%), whereas diastolic dysfunction was present in 109 patients (94 grade 1, 15 grade 2). Half of the patients (7 of 14) referred for angiography with abnormal MVP had significant epicardial disease by angiography, and these patients were revascularized prior to LT. Despite these interventions, the primary outcome still occurred in 9 patients (3%). Patients with abnormal MVP during dobutamine stress perfusion echocardiography had a 7-fold higher risk of a cardiovascular event following LT. Cox proportional hazards modeling examining clinical variables, left ventricular ejection fraction, diastolic function, and stressinduced wall motion abnormalities or MVP defects demonstrated that abnormal MVP was the only independent predictor of the primary outcome (P=0.004; hazard ratio 7.7). Conclusions-Stress MVP assessments are highly predictive of cardiovascular outcome in current LT candidates.

AB - Background-The assessment of cardiac risk in contemporary liver transplantation (LT) has required more sensitive testing for the detection of occult coronary artery disease as well as microvascular and functional cardiac abnormalities. Because dobutamine stress perfusion echocardiography provides an assessment of both regional systolic and diastolic function as well as microvascular perfusion (MVP), we sought to examine its incremental value in this setting. Methods and Results-We evaluated the predictive value of dobutamine stress perfusion echocardiography in 296 adult patients with end-stage liver disease and preserved systolic function who underwent LT between 2008 and 2014. The primary outcome was cardiovascular death, nonfatal myocardial infarction, and/or sustained ventricular arrhythmias following LT. The main causes of liver failure were hepatitis C (25%) and nonalcoholic fatty liver disease (13%). Abnormal MVP during stress was observed in 18 patients (6%), whereas diastolic dysfunction was present in 109 patients (94 grade 1, 15 grade 2). Half of the patients (7 of 14) referred for angiography with abnormal MVP had significant epicardial disease by angiography, and these patients were revascularized prior to LT. Despite these interventions, the primary outcome still occurred in 9 patients (3%). Patients with abnormal MVP during dobutamine stress perfusion echocardiography had a 7-fold higher risk of a cardiovascular event following LT. Cox proportional hazards modeling examining clinical variables, left ventricular ejection fraction, diastolic function, and stressinduced wall motion abnormalities or MVP defects demonstrated that abnormal MVP was the only independent predictor of the primary outcome (P=0.004; hazard ratio 7.7). Conclusions-Stress MVP assessments are highly predictive of cardiovascular outcome in current LT candidates.

KW - Coronary artery disease

KW - Left ventricular ejection fraction

KW - Liver transplantation

KW - Microvascular dysfunction

UR - http://www.scopus.com/inward/record.url?scp=85016049535&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85016049535&partnerID=8YFLogxK

U2 - 10.1161/JAHA.116.005102

DO - 10.1161/JAHA.116.005102

M3 - Article

C2 - 28219921

AN - SCOPUS:85016049535

VL - 6

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 2

M1 - e005102

ER -