title: Preoperative dobutamine stress echocardiography, intraoperative events, and intraoperative myocardial injury in liver transplantation.
abstract: BACKGROUND
  The appropriate method of screening for coronary artery disease in patients who present for liver transplantation is currently uncertain.
  
  
  METHODS
  We assessed the utility of a screening protocol using dobutamine stress echocardiography (DSE) in 119 patients who underwent liver transplantation. Patients with cardiac risk factors had DSE performed, and those with positive results were referred for coronary angiography. Outcome was myocardial injury during liver transplantation determined by an elevation of cardiac troponin T measured after transplantation.
  
  
  RESULTS
  Seventy-three patients had DSE performed; eight were reported as positive for inducible ischemia. Seven of these patients underwent coronary angiography, and one had significant coronary artery disease. Postoperative troponin elevation occurred in 14 patients. There was no significant difference in the prevalence of troponin elevation in those patients with positive DSE versus those with negative DSE. No significant difference was identified in the prevalence of troponin elevation when comparing those patients with cardiac risk factors who underwent DSE with those patients with no risk factors and no DSE performed. DSE had a sensitivity of 0.2 and a specificity of 0.9 for myocardial injury. The prevalence of intraoperative hemodynamic instability was significantly higher in patients who had evidence of myocardial injury, but hemodynamic instability was no more common in patients who had a positive DSE.
  
  
  CONCLUSIONS
  When used in accordance with our protocol a positive DSE does not reliably identify patients at high cardiac risk during liver transplantation, but a negative DSE is strongly predictive of no myocardial injury.
authors.affiliation: Department of Anesthesiology, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 Second Street SW, Rochester, MN 55905, USA.
authors.forename: J Y
authors.initials: JY
authors.lastname: Findlay
authors.forename: M T
authors.initials: MT
authors.lastname: Keegan
authors.forename: P P
authors.initials: PP
authors.lastname: Pellikka
authors.forename: C B
authors.initials: CB
authors.lastname: Rosen
authors.forename: D J
authors.initials: DJ
authors.lastname: Plevak
mesh_terms: D000318:Adrenergic beta-Agonists; D000328:Adult; D015415:Biomarkers / Q000097:blood; D004280:Dobutamine; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006335:Heart Injuries / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007431:Intraoperative Complications; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D020107:Troponin T / Q000097:blood
chemical_list: D000318:Adrenergic beta-Agonists; D015415:Biomarkers; D020107:Troponin T; D004280:Dobutamine