Dobutamine Stress Echocardiography is a Poor Predictor of Clinically Significant Coronary Artery Disease in Patients Undergoing Liver Transplant Evaluation

D. L. Hughes¹, J. Rice¹, J. R. Burton¹, E. A. Pomfret², J. J. Pomposelli², A. V. Ambardekar³, S. M. Mandell⁴, M. S. Kriss¹

¹Division of Gastroenterology & Hepatology, University of Colorado School of Medicine (UCSOM), Aurora, CO, ²Division of Transplant Surgery, UCSOM, Aurora, CO, ³Division of Cardiology, UCSOM, Aurora, CO, ⁴Department of Anesthesiology, UCSOM, Aurora, CO

Meeting: 2019 American Transplant Congress

Abstract number: A317

Keywords: Angiography, Echocardiography, Liver transplantation, Screening

Session Information

Session Name: Poster Session A: Liver: Recipient Selection

Session Type: Poster Session

Date: Saturday, June 1, 2019

Session Time: 5:30pm-7:30pm

Presentation Time: 5:30pm-7:30pm

Location: Hall C & D

*Purpose: Given the high incidence of major cardiac events in the first year post-liver transplantation (LT) (>30%), the aim of this study was to determine the utility of dobutamine stress echocardiography (DSE) to screen for coronary artery disease (CAD) among patients undergoing LT evaluation in order to optimize our pre-LT risk stratification.

*Methods: We conducted a retrospective cohort analysis of 165 patients undergoing LT evaluation including diagnostic coronary angiogram (DCA) at a tertiary medical center from 2012 to 2017. From this cohort, 147 patients had DSE as part of their cardiovascular (CV) risk assessment. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated to determine the performance of DSE to detect presence and severity (non-obstructive; <50% stenosis; obstructive, >50%) of CAD. Post-LT major CV events were recorded in first year post-LT and compared between groups based on presence/severity of CAD using Chi-squared test.

*Results: DSE was a poor predictor of CAD among LT candidates (Table 1). Additionally, we found a high rate of non-diagnostic DSE (N=43 [29%]), primarily due to hypotension and chronotropic incompetence, leading to protocol DCA that demonstrated markedly low yield of clinically significant CAD (N=4 [9%]). Importantly, presence of non-obstructive CAD was associated with increased CV event within 1 year post-LT (13% vs 38%, p=0.029), underscoring the need for better diagnostic tests to identify and medically manage these patients both pre- and post-LT. Three patients with CAD underwent coronary stenting and subsequent LT with a significantly higher 1-year CV event rate (67%).

*Conclusions: DSE is of limited utility in identifying clinically significant CAD among patients undergoing LT evaluation. Patients with both non-obstructive and obstructive CAD had an increased risk of 1-year post-LT CV events, highlighting the need to identify patients with any CAD in pre-LT evaluation. Based on this data, we have now implemented a protocol utilizing CT coronary angiogram for CV risk stratification.

Table 1. Performance of DSE to detect presence and severity of CAD
	Sensitivity	Specificity	Negative Predictive Value	Positive Predictive Value
Non-obstructive CAD	6%	91%	70%	22%
Obstructive CAD	30%	91%	83%	46%

To cite this abstract in AMA style:

Hughes DL, Rice J, Burton JR, Pomfret EA, Pomposelli JJ, Ambardekar AV, Mandell SM, Kriss MS. Dobutamine Stress Echocardiography is a Poor Predictor of Clinically Significant Coronary Artery Disease in Patients Undergoing Liver Transplant Evaluation [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/dobutamine-stress-echocardiography-is-a-poor-predictor-of-clinically-significant-coronary-artery-disease-in-patients-undergoing-liver-transplant-evaluation/. Accessed November 25, 2024.

« Back to 2019 American Transplant Congress