Document Detail

The new index to assess chronotropic response in patients with end stage liver disease undergoing dobutamine stress echocardiography.
MedLine Citation:
PMID:  22140006     Owner:  NLM     Status:  Publisher    
Inability to achieve 85% of the maximum age-predicted heart rate (MPHR) on dobutamine stress echocardiography (DSE) is defined as chronotropic incompetence and is a predictor of major cardiac events after orthotopic liver transplantation (OLT). The majority of end-stage liver disease (ESLD) patients receive beta-blockers for prevention of variceal bleeding. In such cases it is impossible to discern whether chronotropic incompetence is secondary to cirrhotic-related autonomic dysfunction or merely a beta-blocker effect. We evaluated the usefulness of maximum achieved heart rate (MAHR) and heart rate reserve (HRR) in the detection of chronotropic incompetence in ESLD patients who were on beta-blocker therapy prior to DSE. We also evaluated the usefulness of a new index - "modified heart rate reserve" (MHRR) in diagnosing chronotropic incompetence and predicting major cardiovascular adverse events after OLT. Study population consisted of 284 ESLD patients. Mean values of MAHR expressed as percentage of 85% MPHR and HRR were significantly lower in patients on beta-blockers (97.1% vs. 101.6%, t=5.01, p<0.001; 71.7% vs. 77.3%, t=4.03, p<0.001, respectively), while values of MHRR were similar in patients on and off beta-blockers (102.3 vs. 102.1, t=0.94, p=0.965). Regression analysis showed significant association of MAHR and HRR with beta-blockers while MHRR was not associated with beta-blocker treatment (p<0.001, p<0.001, p=0.917; respectively). MAHR and HRR were found to be of no value in the diagnosing of chronotropic incompetence in ESLD patients. MHRR was not affected by beta-blocker therapy. Patients who developed heart failure (HF) and myocardial infarction (MI) after OLT had significantly lower MHRR values on pretransplant DSE. MHRR was significantly associated with subsequent development of HF (p=0.014) and MI (p=0.013) after OLT. MHRR may be useful in determination of target HR for stress testing, diagnosing of chronotropic incompetence and predicting adverse cardiac events post OLT. © 2011 American Association for the Study of Liver Diseases.
Wojciech Rudzinski; Alfonso H Waller; Amit Prasad; Sunita Sood; Christine Gerula; Arun Samanta; Baburao Koneru; Marc Klapholz
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-12-5
Journal Detail:
Title:  Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society     Volume:  -     ISSN:  1527-6473     ISO Abbreviation:  -     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100909185     Medline TA:  Liver Transpl     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 American Association for the Study of Liver Diseases.
Department of Medicine, Division of Cardiology, New Jersey Medical School, Newark, NJ.
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