Dobutamine stress echocardiography in patients undergoing liver transplantation evaluation

Background. Coronary artery disease has an important impact on perioperativ e morbidity and mortality in patients undergoing liver transplantation. To assess the role of dobutamine stress echocardiography (DSE) in these patien ts, DSE was included in the preoperative evaluation. Methods. Patients under consideration for liver transplantation underwent d etailed clinical history, electrocardiography, and echocardiography, Patien ts with documented coronary disease or symptoms of myocardial ischemia unde rwent angiography, The remaining patients with cardiac risk factors, atypic al 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 transplantati on, DSE was normal in 25, nondiagnostic in 34 because of inadequate heart r ate response, and abnormal in two patients. Major perioperative events occu rred in eight patients, all with normal or nondiagnostic DSE studies (negat ive 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 pred ictor of major perioperative events.