Dobutamine stress echocardiography in end-stage liver disease: Insights from pre-transplant cardiac assessment – A cross-sectional prospective study from a tertiary cardiac centre in South India

BACKGROUND: Cardiovascular complications are a significant cause of morbidity and mortality in patients with end-stage liver disease (ESLD) undergoing liver transplantation (LT). Dobutamine stress echocardiography (DSE) is a commonly used tool for cardiac risk stratification, but its predictive utility in this population remains controversial. OBJECTIVE: To evaluate the role of DSE in predicting 30-day cardiac morbidity and mortality in ESLD patients undergoing LT. METHODS: This was a prospective observational study conducted at a tertiary care centre from June 2020 to November 2021. Ninety-four patients aged ≥40 years with ≥2 cardiovascular risk factors underwent DSE as part of their pre-LT evaluation. Patients were categorized based on DSE results as ischemic, non-ischemic, or indeterminate. Outcomes measured included 30-day mortality, major adverse cardiac events (MACE), ICU stay, and inotrope requirement. RESULTS: The study included 94 patients (mean age 53.4 ± 7.8 years; 81 males). DSE results were non-ischemic in 83 (88.3 %), indeterminate in 9 (9.6 %), and ischemic in 2 (2.1 %) patients. Both ischemic and indeterminate cases had non-significant coronary disease. There were 10 deaths (10.6 %) in 30 days, one attributed to cardiac cause. Two MACES were recorded in DSE-negative patients (ACS, HF). Sensitivity of DSE for mortality prediction was 0 %, specificity 97.4 %, and NPV 89.2 %. CONCLUSION: DSE demonstrated high specificity but limited sensitivity in predicting short-term cardiac events in ESLD patients undergoing LT. The utility of DSE as a sole screening in this population appears limited.