Abstract 369: Utility of Stress Echocardiography for Predicting Perioperative Cardiac Outcomes Among Patients Undergoing Liver Transplant Surgery
Background: Stress echocardiography (SE) is used in patients undergoing liver transplant surgery (LTS) for perioperative cardiac event risk assessment. However, the utility of this test for underlying coronary disease remains less well established and controversial in prior publications. Hence, we sought to evaluate this among patients who underwent SE and subsequently LTS.
Methods: Patients who had LTS between 2001– 2005 were studied. The three outcomes analyzed were the occurrence of non-fatal myocardial infarction (MI), death or either outcome over a follow up period of 30 days following LTS. Stepwise logistic regression was used to identify variables associated with cardiac outcomes. Salient variables of clinical demographics, cardiac medications, EKG findings, and postoperative complications were included in the analysis of LTS patients who underwent preoperative dobutamine SE.
Results: Of 356 patients (mean age 51±9 years, 65% male), 89 (25%) were diabetic, 74 (21%) hypertensive and 150 (42%) had history of smoking. Of these, 25 (7.0%) experienced at least one MI, 33 (9.3%) died and 43 (12.1 %) had either outcome within the perioperative period. Final multivariate models for outcomes and sensitivity, specificity, positive predictive value and negative predictive value are shown in tables 1⇓ and 2⇓, respectively.
Conclusion: The utility of SE among patients undergoing LTS is limited with no statistically significant association between abnormal results and adverse cardiac outcomes. However, as previously reported, normal SE response in these patients is associated with a high negative predictive value and able to identify the lower risk patients.