Impaired Cardiac Reserve on Dobutamine Stress Echocardiography Predicts the Development of Hepatorenal Syndrome
| Autor: | Benjamin Cailes, Anoop N Koshy, Jay Ramchand, Omar Farouque, Paul J Gow, Adam G Testro, Jithin K. Sajeev, Elizabeth F Jones, Piyush M Srivastava, Han S. Lim, Hui-Chen Han, Hamid Salehi, Paul Calafiore, Andrew W. Teh |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Liver Cirrhosis Male medicine.medical_specialty Cardiac output Cardiotonic Agents Hepatorenal Syndrome Adolescent Stress testing Kaplan-Meier Estimate Young Adult 03 medical and health sciences 0302 clinical medicine Hepatorenal syndrome Risk Factors Clinical Decision Rules Dobutamine Internal medicine medicine Humans Cardiac Output Aged Proportional Hazards Models Retrospective Studies Aged 80 and over Ejection fraction Hepatology business.industry Hazard ratio Gastroenterology Cardiac reserve Stroke volume Middle Aged medicine.disease 030220 oncology & carcinogenesis Cardiology Female 030211 gastroenterology & hepatology business Echocardiography Stress Follow-Up Studies medicine.drug |
| Zdroj: | American Journal of Gastroenterology. 115:388-397 |
| ISSN: | 1572-0241 0002-9270 |
| DOI: | 10.14309/ajg.0000000000000462 |
| Popis: | OBJECTIVES: Cardiac dysfunction has been implicated in the genesis of hepatorenal syndrome (HRS). It is unclear whether a low cardiac output (CO) or attenuated contractile response to hemodynamic stress can predict its occurrence. We studied cardiovascular hemodynamics in cirrhosis and assessed whether a diminished cardiac reserve with stress testing predicted the development of HRS on follow-up. METHODS: Consecutive patients undergoing liver transplant workup with dobutamine stress echocardiography (DSE) were included. CO was measured at baseline and during low-dose dobutamine infusion at 10 μg/kg/min. HRS was diagnosed using guideline-based criteria. RESULTS: A total of 560 patients underwent DSE, of whom 488 were included after preliminary assessment. There were 64 (13.1%) patients with established HRS. The HRS cohort had a higher baseline CO (8.0 ± 2 vs 6.9 ± 2 L/min; P < 0.001) and demonstrated a blunted response to low-dose dobutamine (ΔCO 29 ± 22% vs 44 ± 32%, P < 0.001) driven primarily by inotropic incompetence. Optimal cutpoint for ΔCO in patients with HRS was determined to be |
| Databáze: | OpenAIRE |
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