Diagnostic yield and prognostic utility of Dobutamine stress echocardiography in preoperative assessment of liver transplant candidates: a retrospective study from the Arabian Gulf region.

Dobutamine stress echocardiography (DSE) is a non-invasive modality frequently used for evaluation of myocardial ischemia in liver transplantation (LT) candidates. We aimed to describe experience with DSE use and examine its diagnostic yield at a liver transplant center in Middle East/ Arabian Gulf region. Consecutive patients referred to DSE in preparation for LT were retrospectively identified (Jan 2018- Dec 2023). Test findings and their association with the occurrence of subsequent testing and postoperative adverse cardiac events (non-fatal MI, all-cause death) within 180 days of LT were examined using logistic regression. Total of 184 patients underwent DSE and LT, of whom 0.5% had an ischemic response during DSE and 18.5% had a non-diagnostic DSE, while the remainder had a normal DSE. Non-diagnostic DSE was strongly associated with subsequent testing (OR 5.6; 95% CI [2.02-15.49], P = 0.001). Rate of postoperative mortality was low, with only 3 patients (1.8%) suffering death within 6 months of LT. In the first reported experience with DSE for LT candidates from Middle East/ Arabian Gulf region, DSE was safe and effective and accurately identified patients at risk for adverse cardiac events post LT. However, 1 in 5 patients had a non-diagnostic DSE which was strongly associated with downstream testing but no increase in risk of events.