Descriptive Analysis of Patients Undergoing Conventional Non-invasive Stress Testing as Part of the Pre-orthotopic Liver Transplant Evaluation

Abstract

Introduction: Patients undergoing orthotopic liver transplantation (OLT) have high rates of cardiac morbidity and mortality. Although guidelines recommend non-invasive stress testing as part of the preoperative evaluation, little data has evaluated clinical outcomes following OLT. Methods: A retrospective study at two high volume liver transplantation centers was performed. All patients undergoing non-invasive stress testing (myocardial perfusion imaging [MPI] or dobutamine stress echocardiography [DSE]) over a 5-year period were included. Descriptive analyses, including clinical outcomes and peri- and post- operative ischemic events, were performed. Comparisons were made between subsets of patients within each stress modality based on abnormal versus normal results. Results: A total of 506 patients were included, of which 343 underwent DSE and 163 MPI. Few patients had abnormal results, with 19 (5.5%) in the DSE group and 13 (8%) in the MPI. Peri- and post-operative cardiac complications were low (n=20, 5.8% and n=3, 0.9% in DSE group and n=15, 9.2% and n=3, 1.8% in MPI group). Comparisons between abnormal versus normal findings showed a trend toward periprocedural cardiac complications in the abnormal DSE group (n=3, 15.8% versus n=17, 5.25%; p=0.09) with no difference in 6-month post-procedural complications (n=0 versus n=3, 0.9%; p=1.0). In the MPI group, no difference in peri-procedural ischemic complications (n=3, 23.1% versus n=12, 8%; p=0.1) or 6-month post-procedural complications (n=0 versus n=3, 2%; p=1.0) was noted. Conclusion: Our study found a significantly lower than reported cardiac event rate. Additionally, it demonstrated that ischemic cardiac events are uncommon in patients with normal non-invasive stress testing.