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Value of dobutamine stress myocardial contrast perfusion echocardiography in patients with advanced liver disease
Author(s) -
Tsutsui Jeane M.,
Mukherjee Sandeep,
Elhendy Abdou,
Xie Feng,
Lyden Elizabeth R.,
O'Leary Edward,
McGrain Anna C.,
Porter Thomas R.
Publication year - 2006
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.20651
Subject(s) - medicine , dobutamine , cardiology , myocardial perfusion imaging , hazard ratio , liver transplantation , liver disease , clinical endpoint , myocardial infarction , confidence interval , population , perfusion , transplantation , clinical trial , hemodynamics , environmental health
Although dobutamine stress echocardiography has been used for the preoperative evaluation of patients with advanced liver disease (ALD), no data exist regarding the value of myocardial perfusion imaging (MPI) with real‐time myocardial contrast echocardiography (RTMCE) in this patient population. We sought to determine the value of MPI during dobutamine stress RTMCE for predicting prognosis in patients with ALD. We examined both wall motion and MPI in 230 patients with ALD who underwent dobutamine stress RTMCE using intravenous commercially available contrast agents (Optison, GE‐Amersham, Princeton, NJ; or Definity, Bristol‐Myers Squibb Medical Imaging, North Billerica, MA). The prognostic value of clinical variables, including the Model for End‐Stage Liver Disease (MELD) score, and echocardiographic data were examined using a Cox Hazard model. The primary endpoint was mortality of all causes. Among the 85 patients who underwent orthotopic liver transplantation, 4 had abnormal MPI and 81 had normal perfusion. The hospital mortality rate was 50% (2/4) in patients with abnormal MPI and 2% (2/81) in patients with normal MPI ( P = 0.01). Among patients with abnormal MPI, 1 died from myocardial infarction in the first postoperative day and the second 1 from hemorrhagic shock. During a median follow‐up of 15 months, 53 (23%) patients died. The independent predictors of death were an age of ≥65 yr (RR = 2.2; 95% confidence interval (CI) = 1.1–4.4; P = 0.03), MELD score of ≥25 (RR = 3.2; 95% CI = 1.8–5.5; P < 0.0001), and abnormal MPI (RR = 2.4; 95% CI = 1.1–5.2; P = 0.02). The 2‐yr mortality was 24% for patients with normal MPI and 45% for those with inducible MPI abnormalities ( P = 0.003). In conclusion, MPI obtained by RTMCE appears to be a useful tool in predicting mortality in patients with ALD. Further studies are required to verify its independent value. Liver Transpl 12:592–599, 2006. © 2006 AASLD.