Author + information
- Received March 29, 2018
- Revision received October 15, 2018
- Accepted October 19, 2018
- Published online January 16, 2019.
- Anisiia T. Doytchinova, MDa,b,∗ (, )
- Thomas D. Feigenbaum, MSa,
- Roja C. Pondicherry-Harish, MDa,
- Peter Sepanski, PhDa,
- Deborah Green-Hess, BSa,
- Harvey Feigenbaum, MDa and
- Stephen G. Sawada, MDa
- aKrannert Institute, Indiana University School of Medicine and IU Health, Indianapolis, Indiana
- bDivision of Cardiovascular Health and Disease, University of Cincinnati Medical Center, Cincinnati, Ohio
- ↵∗Address for correspondence:
Dr. Anisiia Doytchinova, University of Cincinnati Medical Center, 231 Albert Sabin Way, MLC 0542, Cincinnati, Ohio 45267.
Objectives This study determined the test performance of dobutamine stress echocardiography (DSE) in end-stage liver disease (ESLD).
Background The reported sensitivity of DSE in ESLD has been variable.
Methods Data from 633 ESLD patients who had coronary angiography within 6 months after DSE was analyzed.
Results The prevalence of coronary arterial disease (CAD) (≥70% stenosis by quantitative angiography) was 12% (74 of 633 patients). DSE sensitivity was 24% (17 of 72 patients), and specificity was 90% (503 of 559 patients). The positive and negative predictive values were 23% (17 of 73 patients) and 90% (503 of 558 patients), respectively. Stratifying the cohort into low-, intermediate-, and high-risk CAD groups yielded sensitivities of 0%, 21%, and 32%, respectively. Independent predictors of an accurate ischemic DSE result included left ventricular internal dimension at end-diastole (LVIDd) >4.8 cm and assigning ischemia based on tardokinesis or lack of low-to-peak dose hyperkinesis (p < 0.05 for all). DSE sensitivity was 38% in LVIDd >4.8 cm versus 13% with LVIDd ≤4.8 cm (p = 0.013). The sensitivity was 67% when tardokinesis or lack of hyperkinesis was considered abnormal versus 15% (p < 0.001) for readings that did not consider tardokinesis or lack of hyperkinesis abnormal. There was a higher frequency of cardiac events in patients with significant CAD who had abnormal (45%) versus normal (18%) DSE (p = 0.01).
Conclusions The sensitivity of DSE in ESLD was low. DSE sensitivity was higher for those with larger cavity dimension and when tardokinesis or lack of hyperkinesis was considered abnormal. An abnormal DSE in those with significant CAD was associated with worse outcome.
- dobutamine stress echocardiogram
- end-stage liver disease
- left ventricular internal dimension at end-diastole
- rate−pressure product
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 29, 2018.
- Revision received October 15, 2018.
- Accepted October 19, 2018.
- 2019 American College of Cardiology Foundation
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