Chronotropic incompetence on dobutamine stress echocardiography in candidates for a liver transplant

Ashish Singhal, Amar Nath Mukerji, Athanasios Thomaides, Andreas Karachristos, Manoj Maloo, Benjamin Sanchez, Michael Keresztury, Thomas A. Santora, Ashokkumar Jain

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Objectives: We evaluated dobutamine stress echocardiography as an initial screening test for a cardiac evaluation before a liver transplant. Materials and 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 chrono - tropically 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 candi dates 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 chrono tro pically 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.

Original languageEnglish (US)
Pages (from-to)546-553
Number of pages8
JournalExperimental and Clinical Transplantation
Volume11
Issue number6
DOIs
StatePublished - Dec 2013

All Science Journal Classification (ASJC) codes

  • Transplantation

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