title: Dobutamine stress echocardiography in patients undergoing orthotopic liver transplantation: a pooled analysis of accuracy, perioperative and long term cardiovascular prognosis.
abstract: Pre-transplant evaluation for orthotopic liver transplantation (OLT) commonly includes a cardiac evaluation using dobutamine stress echocardiography (DSE). We performed a quantitative systematic review assessing DSE's use in detecting coronary artery disease (CAD) and predicting perioperative and long term cardiac events in patients undergoing OLT. Published studies in pubmed were accessed using keyword searches and bibliographic review. Included studies evaluated the use of DSE in patients undergoing OLT, including its accuracy for detection of CAD, and in predicting perioperative and long term cardiac prognosis for both hard (myocardial infarction, cardiac death, cardiac arrest, and asystole) and soft cardiac events (all other events that were cardiovascular in nature). We calculated DSE's sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) in the above areas. We identified 7 studies, including a total of 580 patients, which included 4 accuracy studies (n = 110 patients), 4 perioperative studies, and 3 long term studies. Accuracy for CAD included a sensitivity of 0.32, specificity of 0.78, PPV of 0.37, and NPV of 0.75. Accuracy for prediction of perioperative hard and soft cardiac events was a sensitivity of 0.20 and 0, specificity of 0.99 and 0.99, PPV of 0.33 and 0, and NPV of 0.98 and 0.89, respectively. For long term hard and soft cardiac events, sensitivity was 0.5 and 0, specificity 0.99 and 0.98, PPV 0.33 and 0, and NPV 0.99 and 0.96, respectively. DSE has a limited accuracy for the detection of CAD in candidates for OLT. However, among those patients selected for OLT, the negative predictive value of DSE for both perioperative and long term cardiac events is high.
authors: Division of Cardiology, Medstar Georgetown University Hospital, Georgetown University School of Medicine, 3800 Reservoir Rd., NW, PHC5, Washington, DC, 20007, USA.
authors: Peter
authors: P
authors: Nguyen
authors: Jeff
authors: J
authors: Plotkin
authors: Thomas M
authors: TM
authors: Fishbein
authors: Jacqueline M
authors: JM
authors: Laurin
authors: Rohit
authors: R
authors: Satoskar
authors: Kirti
authors: K
authors: Shetty
authors: Allen J
authors: AJ
authors: Taylor
mesh_terms: D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D025401:Echocardiography, Stress; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
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