*Purpose: Dobutamine stress echocardiography (DSE) is an effective tool for perioperative cardiac risk stratification in patients without end-stage liver disease (ESLD). However, DSE is frequently used in cardiac risk stratification in patients with ESLD despite its documented lower sensitivity. We investigated whether abnormal hemodynamic response to DSE could improve the sensitivity of the test in this patient population.

*Methods: A retrospective chart review of all patients who underwent DSE prior to orthotopic liver transplantation (OLT) at the University of Wisconsin Hospital from 2009 – 2018 was performed to determine if hypotension (a decrease in systolic blood pressure of ≥20 mmHg from the peak pressure during the infusion protocol or an absolute systolic blood pressure ≤80 mmHg), hypertension (a systolic blood pressure of ≥180 mmHg), and/or inability to achieve 85% maximum predicted heart rate (MPHR) during the test were associated with major adverse cardiac events (MACE). Data were analyzed with conventional bivariate tests and logistic regression.

*Results: 412 patients were included in analysis with 68.5% male and 31.5% female with a median age at transplant of 57.4 (51.3-61.9). Etiologies for liver disease included 43% alcoholic, 18% non-alcoholic fatty liver disease, 14% autoimmune, 10% hepatitis C, and 7.5% for both malignancy and other causes. The incidence of MACE was 27.3%. There was no correlation between a hypotensive response (p=0.52) or an inability to obtain 85% MPHR (p=0.28) and MACE. There was a trend toward significance with hypertensive response (p=0.06) including a significant correlation between increasing systolic blood pressure and the incidence of MACE (p=0.01).

*Conclusions: Hypotensive response or inability to achieve 85% MPHR on DSE do not appear to predict MACE in this patient population though hypertensive response may. Future prospective studies will be needed to further investigate these findings.

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