The role of Dobutamine stress echocardiography in patients evaluated for liver transplant to predict latent cardiac disease

• Liver transplant patients with cardiac disease suffer remarkably high perioperative mortality, necessitating a methodical, preferably non-invasive, cardiac evaluation. • Till date, no diagnostic test has proven a conclusive superiority over the other, as a screening tool. • Dobutamine stress echocardiography (DSE), although commonly used, has a questionable performance accuracy in patients evaluated for liver transplant. • In this study, the sensitivity of DSE was 7%, specificity of DSE was 64%, positive predictive value was 16% and negative predictive value was 40 %. • Dobutamine stress echocardiography did not also predict peri-operative clinical outcomes in this subset. Dobutamine stress echocardiography (DSE) is a frequently used diagnostic tool in the cardiac assessment of patients evaluated for liver transplant. But it's precision to predict obstructive coronary artery disease (CAD) or cardiomyopathy has been subject to much debate. The aim of this study is to assess the efficacy of DSE in diagnosing latent CAD in pre-liver transplant evaluation. This is a prospective, single center, observational study. 109 patients with no prior history of CAD, and baseline normal left ventricular function, who underwent DSE as a part of pre-transplant work-up from December 2016 to June 2018 were included in our study. Left ventricular ejection fraction (LVEF) at peak stress, new wall motion abnormalities, achievement of contractile reserve (CR) were noted. Coronary angiography (CAG) was performed in patients who had either positive DSE or significant risk factors for CAD. Patients were observed post operatively up to their discharge for cardiac events. Only one patient with positive DSE had CAD by angiogram (16.6%) whereas 46.4% (n=13) with negative DSE had CAD. Among the patients with normal epicardial coronaries, 83.3% (n=5) had positive DSE (‘p’=0.016). The sensitivity of DSE was 7%, specificity of DSE was 64%, positive predictive value was 16% and negative predictive value was 40 %. In-hospital mortality was 16% (n=15). Among them none had a positive DSE and all 6 patients with positive DSE were alive at the time of discharge (p= 0.26). The performance accuracy of DSE to detect latent CAD in patients undergoing liver transplant is poor.