Orthotopic
liver transplantation is an established
therapy for
end-stage liver disease. This study evaluated the range of
cardiovascular abnormalities in patients undergoing evaluation for orthotopic
liver transplantation and determined the prognostic implications of abnormal echocardiographic features, including
ischemia during
dobutamine stress echocardiography, in predicting postoperative
cardiac events. Two-dimensional echocardiography was performed in 190 patients for assessment of left ventricular function, valvular pathology, and
pulmonary hypertension.
Dobutamine stress echocardiography was performed in 165 patients for evaluation of inducible
ischemia. Contrast echocardiography for detection of intrapulmonary shunting was performed in 125 patients at rest and in 99 during
dobutamine stress.
Left ventricular dysfunction, significant valvular regurgitation, and inducible
ischemia were identified in <1O% of patients.
Pulmonary hypertension,
left ventricular hypertrophy and > or = moderate intrapulmonary shunting were present in 12%, 16%, and 26% of patients, respectively. Severe intrapulmonary shunting predicted death prior to
transplantation (P=0.01). Of the 71 transplanted patients, major perioperative events included global
left ventricular dysfunction in four patients and
myocardial infarction in one patient with normal coronary arteries. No preoperative echocardiographic parameters, including
ischemia on
dobutamine echocardiography, predicted these perioperative events. No
cardiac events related to obstructive
coronary artery disease occurred in the 154 patients without
ischemia on
dobutamine stress echocardiography. The majority of patients with
end-stage liver disease, including those with
alcoholic cirrhosis, have normal cardiac function on two-dimensional echocardiography. Severe intrapulmonary shunting portends a poor prognosis in patients awaiting
transplantation. A negative
dobutamine stress echocardiogram appears useful in excluding patients at risk for perioperative
cardiac events related to obstructive
coronary artery disease.