Usefulness for Predicting Cardiac Events After Orthotopic Liver Transplantation of Myocardial Perfusion Imaging and Dobutamine Stress Echocardiography Preoperatively.
Patients undergoing orthotopic liver transplantation have high rates of cardiac morbidity and mortality. Although guidelines recommend noninvasive stress testing as part of the preoperative evaluation, little data have evaluated clinical outcomes following orthotopic liver transplantation. A retrospective study at 2 high-volume liver transplantation centers was performed. All patients undergoing noninvasive stress testing (myocardial perfusion imaging [MPI] or dobutamine stress echocardiography [DSE]) over a 5-year period were included. Descriptive analyses, including clinical outcomes and perioperative and postoperative ischemic events, were performed. Comparisons were made between subsets of patients within each stress modality based on abnormal versus normal results. A total of 506 patients were included, of which 343 underwent DSE and 163 MPI. Few patients had abnormal results, with 19 (5.5%) in the DSE group and 13 (8%) in the MPI group. Perioperative and postoperative cardiac complications were low (n = 20, 5.8% and n = 3, 0.9% in DSE group and n = 15, 9.2% and n = 3, 1.8% in MPI group). Comparisons between abnormal versus normal findings showed a trend toward periprocedural cardiac complications in the abnormal DSE group (n = 3, 15.8% vs n = 17, 5.25%; p = 0.09) with no difference in 6-month postprocedural complications (n = 0 vs n = 3, 0.9%; p = 1.0). In the MPI group, a trend toward periprocedural ischemic complications (n = 3, 23.1% vs n = 12, 8%; p = 0.1) was noted with no difference in 6-month postprocedural complications (n = 0 vs n = 3, 2%; p = 1.0). In conclusion, our study found a significantly lower than reported cardiac event rate. In addition, it demonstrated that ischemic cardiac events are uncommon in patients with normal stress testing.
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. Electronic address: Snipelisky.david@mayo.edu.
David
D
Snipelisky
Division of Internal Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida.
Jordan
J
Ray
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
Saraschandra
S
Vallabhajosyula
Division of Internal Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida.
Gautam
G
Matcha
Department of Radiology, Mayo Clinic, Jacksonville, Florida.
Samuel
S
Squier
Department of Radiology, Mayo Clinic, Jacksonville, Florida.
Jacob
J
Lewis
Department of Radiology, Mayo Clinic, Jacksonville, Florida.
Rex
R
Holliday
Division of Cardiovascular Diseases, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin.
Niti
N
Aggarwal
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
J Wells
JW
Askew
Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida.
Brian
B
Shapiro
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Nandan
N
Anavekar
D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology; D004280:Dobutamine; D025401:Echocardiography, Stress; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D055414:Myocardial Perfusion Imaging; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D012307:Risk Factors
D004280:Dobutamine