Abstract 15093: Feasibility of Dobutamine Stress Echocardiography as a Screening Modality for Evaluating Coronary Artery Disease Prior to Orthotopic Liver Transplantation
Background: Dobutamine stress echocardiography (DSE) is commonly used to screen coronary artery disease (CAD) and risk stratify patients before orthotopic liver transplantation (OLT). The purpose of this study is to determine the sensitivity, specificity and predictive value of DSE as a screening tool for CAD among end stage liver disease (ESLD) patients undergoing OLT.
Methods: A retrospective chart review of 144 patients who underwent OLT was performed. Pre and post-transplant (1 year follow up) clinical, laboratory and imaging data including left heart catheterization (LHC) were reviewed. Significant CAD was defined as 50% or greater occlusion in the Left Main vessel or 70% or greater in other major coronary vessels. Complications during DSE such as hypotension, sustained and non-sustained ventricular arrhythmias, new onset of atrial fibrillation were documented.
Results: Our study population was composed of 63.9% Caucasians, 23.6% African-Americans, 9.7% Hispanics and 2.8% Asians. The male to female ratio was 2.1:1 with mean age of 56.1 years (± 9.3 years). The most common cause of ESLD in our population was hepatitis C virus (56.9%), followed by alcoholic ESLD (38.19%). Twenty-five patients (17.4%) did not have a stress test prior to OLT. Remaining 119 patients underwent DSE, of which 15 (12.6%) had positive DSE and 104 (87.4%) had negative DSE. None of the patients with positive DSE had significant CAD on their LHC. In our cohort DSE had a sensitivity of 0%, specificity of 87.4%, PPV of 0% and NPV of 100%. The overall complication rate of DSE was 8.1%.
Conclusion: DSE successfully rules out CAD in ESLD patients undergoing liver transplant (NPV= 100%). However, low sensitivity and fairly significant complication rate exhibited in this study questions its universal application in screening for CAD in patients with ESLD. Alternative screening modalities might help in avoiding unnecessary invasive procedures and study complications.
Author Disclosures: A. Agrawal: None. A. Dias: None. A. Kalla: None. V. Jorge: None. S. Campos: None. V. Figueredo: None.
- © 2016 by American Heart Association, Inc.