{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T06:13:33Z","timestamp":1789020813401,"version":"build-2803163510"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2017,2,2]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              The assessment of cardiac risk in contemporary liver transplantation (\n              <jats:styled-content style=\"fixed-case\">LT<\/jats:styled-content>\n              ) has required more sensitive testing for the detection of occult coronary artery disease as well as microvascular and functional cardiac abnormalities. Because dobutamine stress perfusion echocardiography provides an assessment of both regional systolic and diastolic function as well as microvascular perfusion (\n              <jats:styled-content style=\"fixed-case\">MVP<\/jats:styled-content>\n              ), we sought to examine its incremental value in this setting.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We evaluated the predictive value of dobutamine stress perfusion echocardiography in 296 adult patients with end\u2010stage liver disease and preserved systolic function who underwent\n              <jats:styled-content style=\"fixed-case\">LT<\/jats:styled-content>\n              between 2008 and 2014. The primary outcome was cardiovascular death, nonfatal myocardial infarction, and\/or sustained ventricular arrhythmias following\n              <jats:styled-content style=\"fixed-case\">LT<\/jats:styled-content>\n              . The main causes of liver failure were hepatitis C (25%) and nonalcoholic fatty liver disease (13%). Abnormal\n              <jats:styled-content style=\"fixed-case\">MVP<\/jats:styled-content>\n              during stress was observed in 18 patients (6%), whereas diastolic dysfunction was present in 109 patients (94 grade 1, 15 grade 2). Half of the patients (7 of 14) referred for angiography with abnormal\n              <jats:styled-content style=\"fixed-case\">MVP<\/jats:styled-content>\n              had significant epicardial disease by angiography, and these patients were revascularized prior to\n              <jats:styled-content style=\"fixed-case\">LT<\/jats:styled-content>\n              . Despite these interventions, the primary outcome still occurred in 9 patients (3%). Patients with abnormal\n              <jats:styled-content style=\"fixed-case\">MVP<\/jats:styled-content>\n              during dobutamine stress perfusion echocardiography had a 7\u2010fold higher risk of a cardiovascular event following\n              <jats:styled-content style=\"fixed-case\">LT<\/jats:styled-content>\n              . Cox proportional hazards modeling examining clinical variables, left ventricular ejection fraction, diastolic function, and stress\u2010induced wall motion abnormalities or\n              <jats:styled-content style=\"fixed-case\">MVP<\/jats:styled-content>\n              defects demonstrated that abnormal\n              <jats:styled-content style=\"fixed-case\">MVP<\/jats:styled-content>\n              was the only independent predictor of the primary outcome (\n              <jats:italic>P<\/jats:italic>\n              =0.004; hazard ratio 7.7).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Stress\n              <jats:styled-content style=\"fixed-case\">MVP<\/jats:styled-content>\n              assessments are highly predictive of cardiovascular outcome in current LT candidates.\n            <\/jats:p>\n          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