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Updated: Feb 10, 2026
Orthotopic Liver Transplantation in Rats
Published on: July 1, 2012
Preoperative dobutamine stress echocardiography in patients undergoing orthotopic liver transplantation
Krishna K Patel1, Laura Young1, William Carey2
1Department of Cardiovascular Medicine, Stress Echocardiography Laboratory, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Insights
Dobutamine stress echocardiography (DSE) before liver transplant has a low incidence of ischemia and does not predict 30-day outcomes. Left ventricular ejection fraction is key for long-term survival post-transplant.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Coronary artery disease (CAD) increases mortality risk in orthotopic liver transplantation (OLT) patients.
- Dobutamine stress echocardiography (DSE) is preferred for preoperative CAD evaluation in OLT candidates due to chronic vasodilation and poor exercise tolerance.
Purpose of the Study:
- To determine the incidence of positive DSE results before OLT.
- To assess the association between DSE findings and perioperative and longer-term adverse events following OLT.
Main Methods:
- A retrospective study of 460 patients undergoing DSE within one year prior to OLT (2004-2011).
- Primary outcomes included 30-day mortality and myocardial infarction (MI) post-OLT.
- Longer-term mortality was also recorded.
Main Results:
- Only 0.9% of patients showed an ischemic response on DSE; 21% had nondiagnostic results.
- 3% of patients experienced a primary 30-day event (13 deaths, 1 NSTEMI).
- No patient with DSE-detected ischemia had a 30-day event. Left ventricular ejection fraction predicted longer-term mortality.
Conclusions:
- Pre-OLT DSE reveals a low incidence of ischemic responses.
- DSE results, whether ischemic or nondiagnostic, did not correlate with 30-day post-OLT adverse events.
- Baseline left ventricular ejection fraction is a significant predictor of long-term survival after OLT.
Background:
Coronary artery disease (CAD) is associated with increased mortality in patients who undergo orthotopic liver transplantation (OLT). Chronic vasodilatory state and poor exercise tolerance in patients with end-stage liver disease make dobutamine stress echocardiography (DSE) preferred for preoperative evaluation of CAD prior to OLT. We studied the incidence of positive DSE results and the association between DSE results and perioperative and longer-term events.
Hypothesis:
DSE results pre-OLT will predict short and long term outcomes.
Methods:
We studied 460 patients who underwent DSE within 1 year prior to OLT between 2004 and 2011. Primary events included death and MI at 30 days post-OLT. We also recorded longer-term deaths.
Results:
Four patients (0.9%) had an ischemic response to DSE, 360 (78%) were normal, and 96 (21%) were nondiagnostic. Fourteen patients (3%) had a primary event at 30 days following OLT (13 deaths and 1 NSTEMI), and there were 108 (24%) deaths at 4.6±2 years of follow-up. No patient with ischemia on DSE had a 30-day event. The accuracy, sensitivity, specificity, and positive and negative predictive values of DSE that was not normal (ie, ischemic or nondiagnostic response) to predict 30-day post-OLT events were 76%, 14%, 78%, 2%, and 97%, respectively. On Cox survival analysis, only baseline left ventricular ejection fraction (HR: 0.90, 95% CI: 0.85-0.96, P < 0.001) was associated with longer-term deaths.
Conclusions:
Patients undergoing pre-OLT DSE have very low incidence of an ischemic response on DSE, and it has no association with 30-day events.
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