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Research Article Open Access

Prognosis of Patients with Advanced Liver Disease and Positive Stress Echocardiograms: Impact of Coronary Artery Disease, Non-alcoholic Steatohepatitis, and Beta-blocker Therapy

  • 1Lehigh Valley Heart and Vascular Institute, 1250 S. Cedar Crest Blvd, St 300, Allentown PA 18103, USA
  • 2Krannert Institute of Cardiology, Indiana University School of Medicine, IU Health, Indianapolis, IN, USA
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Corresponding Author

Kutaiba Nazif, kutaiba.nazif@gmail.com

Received Date: May 31, 2022

Accepted Date: August 16, 2022

Abstract

Background: In the general population, a positive dobutamine stress echocardiogram (DSE) in the absence of obstructive coronary artery disease (CAD) still identifies a high risk group. DSE is a widely employed screening method in candidates for liver transplantation. We investigated the prognostic impact of a positive DSE, CAD, and clinical factors in advanced liver disease.

Methods: We obtained follow-up for cardiovascular events (angina requiring revascularization, heart failure, infarction, and cardiac death) in 61 liver transplant candidates who had positive DSE and coronary angiography. Event-free survival was compared between 22 patients with obstructive CAD (≥ 70% stenosis) and 39 patients with no obstructive CAD. Cox regression was used to identify factors associated with events.

Results: Over a mean follow-up of 27 ± 28 months, 21% (8/39) of patients with positive DSE and no CAD had events compared with 45% (10/22) of patients with positive DSE and CAD (p = 0.04). Event free survival was better in those without CAD (p = 0.014) but one year cardiac mortality was similar in those with (9%) and without CAD (8%). Multivariable analysis showed that beta blocker use (HR: 4.1, 95% CI: 1.7 – 9.9, p-value = 0.010), CAD (HR: 4.4 95% CI: 1.8– 10.8, p-value = 0.008), and non-alcoholic steatohepatitis (NASH) (HR: 4.9, 95% CI: 2.0 – 11.7, p-value = 0.04) were independently associated with events.

Conclusion: Advanced liver disease patients with positive DSE are at increased risk. CAD, beta blocker use and NASH are independently associated with cardiac events.

Keywords

Dobutamine stress echo, End-stage liver disease, Coronary artery disease

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