Value of dobutamine stress myocardial contrast perfusion echocardiography in patients with advanced liver disease

Jeane M. Tsutsui, Sandeep Mukherjee, Abdou Elhendy, Feng Xie, Elizabeth R. Lyden, Edward O'Leary, Anna C. McGrain, Thomas R. Porter

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)592-599
Number of pages8
JournalLiver Transplantation
Volume12
Issue number4
DOIs
StatePublished - Apr 2006
Externally publishedYes

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Myocardial Perfusion Imaging
Dobutamine
Echocardiography
Liver Diseases
Perfusion
End Stage Liver Disease
Mortality
Confidence Intervals
Proportional Hazards Models
Stress Echocardiography
Hemorrhagic Shock
Diagnostic Imaging
Hospital Mortality
Liver Transplantation
Contrast Media
Myocardial Infarction

All Science Journal Classification (ASJC) codes

  • Surgery
  • Transplantation

Cite this

Value of dobutamine stress myocardial contrast perfusion echocardiography in patients with advanced liver disease. / Tsutsui, Jeane M.; Mukherjee, Sandeep; Elhendy, Abdou; Xie, Feng; Lyden, Elizabeth R.; O'Leary, Edward; McGrain, Anna C.; Porter, Thomas R.

In: Liver Transplantation, Vol. 12, No. 4, 04.2006, p. 592-599.

Research output: Contribution to journalArticle

Tsutsui, JM, Mukherjee, S, Elhendy, A, Xie, F, Lyden, ER, O'Leary, E, McGrain, AC & Porter, TR 2006, 'Value of dobutamine stress myocardial contrast perfusion echocardiography in patients with advanced liver disease', Liver Transplantation, vol. 12, no. 4, pp. 592-599. https://doi.org/10.1002/lt.20651
Tsutsui, Jeane M. ; Mukherjee, Sandeep ; Elhendy, Abdou ; Xie, Feng ; Lyden, Elizabeth R. ; O'Leary, Edward ; McGrain, Anna C. ; Porter, Thomas R. / Value of dobutamine stress myocardial contrast perfusion echocardiography in patients with advanced liver disease. In: Liver Transplantation. 2006 ; Vol. 12, No. 4. pp. 592-599.
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