title: Chronotropic incompetence on dobutamine stress echocardiography in candidates for a liver transplant.
abstract: OBJECTIVE
  We evaluated dobutamine stress echocardiography as an initial screening test for a cardiac evaluation before a liver transplant.
  
  
  METHODS
  We retrospectively examined 111 liver transplant candidates who had undergone previous cardiac evaluation; 30 of whom had undergone a liver transplant.
  
  
  RESULTS
  Eighty patients (72.1%) completed a dobutamine stress echocardiography (41 chronotropically competent, 39 incompetent), while 31 patients (27.9%) required us to terminate early. Overall, 68 patients (61%) were on β-blockers (21 required early dobutamine stress echocardiography termination, 30 chronotropically incompetent, and 17 competent). Patient results were normal. Thirty patients underwent a liver transplant. Among candidates requiring termination of early dobutamine stress echocardiography, posttransplant cardiac events included 1 fatal acute myocardial infarction, 1 nonfatal acute myocardial infarction, and 1 idiopathic cardiomyopathy. Among chronotropically incompetent patients, 2 patients had transient bradycardia, and among those who were chronotropically competent, 1 had refractory atrial fibrillation, and 1 had transient bradycardia.
  
  
  CONCLUSIONS
  Nearly 50% of patients with end-stage liver disease may not reach the target heart rate. Early termination of dobutamine stress echocardiography because of cardiac symptoms or significant echocardiographic changes have more effect in predicting postoperative cardiac events, but further evaluation is required even if their target heart rate is close to that desired. Lower target heart rate may be acceptable in chronotropically incompetent individuals provided they are asymptomatic, have no echocardiographic changes, or cardiovascular risk factors, especially if they are on β-blockers.
authors.affiliation: Division of Abdominal Organ Transplantation, Department of Surgery, Temple University Hospital, Philadelphia, PA 19140 USA.
authors.forename: Ashish
authors.initials: A
authors.lastname: Singhal
authors.forename: Amar Nath
authors.initials: AN
authors.lastname: Mukerji
authors.forename: Athanasios
authors.initials: A
authors.lastname: Thomaides
authors.forename: Andreas
authors.initials: A
authors.lastname: Karachristos
authors.forename: Manoj
authors.initials: M
authors.lastname: Maloo
authors.forename: Benjamin
authors.initials: B
authors.lastname: Sanchez
authors.forename: Michael
authors.initials: M
authors.lastname: Keresztury
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Santora
authors.forename: Ashokkumar
authors.initials: A
authors.lastname: Jain
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D001919:Bradycardia / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D025401:Echocardiography, Stress; D058625:End Stage Liver Disease / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011300:Preoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists