Blunted hemodynamic response to pharmacological stress is predictive of mortality in liver transplant candidates.

IF 2.7 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology Pub Date : 2025-08-05 DOI:10.1016/j.nuclcard.2025.102454

Ibolya Csecs, Aakanksha Sharma, Vandana Khungar, Albert J Sinusas, Stephen Possick, Edward J Miller, Attila Feher

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引用次数: 0

Abstract

Background: The optimal method for evaluating coronary artery disease in liver transplant candidates (LTCs) remains controversial. To date no studies have compared the hemodynamic and symptomatic response to vasodilator stress between LTCs and patients without chronic liver disease.

Methods: We conducted a retrospective study of LTCs who underwent regadenoson nuclear stress testing with either ^99mTc-tetrofosmin single-photon emission computed tomography (SPECT; N = 224) or ⁸²Rubidium positron emission tomography (N = 36). These patients were compared to controls matched for age, sex, body mass index, cardiovascular comorbidities, and imaging modality who underwent clinically indicated regadenoson stress test.

Results: LTCs were less likely to experience symptoms in response to regadenoson than controls (65% vs 86 %, P < .001). Additionally, the increase in heart rate was blunted in LTCs (ΔHR: 13 beats per minute [bpm], interquartile range [IQR]: 11-15 vs 29 bpm, IQR: 27-31, P < .001). During the median follow-up period of 2.0 ± 1.5 years, 78 deaths occurred in LTCs. In the multivariable analysis, ΔHR (hazard ratio [HZR]: .975, 95% confidence interval [CI]: .951-.999, P = .042) and changes in diastolic blood pressure (ΔDBP, HZR: 1.037, 95% CI: 1.003-1.071, P = .031) were significantly associated with mortality regardless of Model for End-stage Liver Disease (MELD) score, age, cardiovascular comorbidities, and stress test results. In addition, LTCs with both high MELD score (≥15) and low ΔHR (≤10 bpm) had worse overall survival than patients with a low MELD score (<15) and high ΔHR (>10 bpm, HZR: 5.54, 95% CI: 3.21-9.53, P < .001), low MELD score and low ΔHR (HZR: 6.62, 95% CI: 3.25-13.49, P < .001), and high MELD score and low ΔHR (HZR: 2.91, 95% CI: 1.50-5.64, P = .002).

Conclusions: In this retrospective cohort analysis, LTCs exhibited a reduced hemodynamic response detected as lower ΔHR as well as fewer symptoms in response to regadenoson during stress testing. Reduced hemodynamic response was significantly associated with mortality and provided incremental prognostic value in addition to MELD score. Further prospective studies are required to validate these findings.

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对药物应激的钝化血流动力学反应可预测肝移植候选者的死亡率。

背景：评估肝移植候选者（LTCs）冠状动脉病变（CAD）的最佳方法仍存在争议。到目前为止，还没有研究比较LTCs和非慢性肝病患者对血管扩张剂应激的血流动力学和症状反应。方法：我们对使用99mTc-tetrofosmin SPECT （n=224）或82Rubidium PET （n=36）进行核应激测试的LTCs进行了回顾性研究。将这些患者与对照组进行年龄、性别、体重指数、心血管合并症和影像学方式相匹配的对照，并进行临床指示的再腺苷松压力测试。结果：与对照组相比，LTCs对regadenoson的反应不太可能出现症状（65%对86%，p< 0.001）。此外，LTCs的心率增加被减弱（ΔHR， 13次/分钟[bpm]，四分位数范围：11-15 vs. 29 bpm，四分位数范围：27-31，p< 0.001）。中位随访期为2.0±1.5年，LTCs患者死亡78例。在多因素分析中，ΔHR（风险比[HR]: 0.975, 95%可信区间[CI]: 0.951-0.999, p=0.042）和舒张压变化（ΔDBP, HR: 1.037, 95% CI: 1.003-1.071, p=0.031）与死亡率显著相关，与终末期肝病模型（MELD）评分、年龄、心血管合并症和压力测试结果无关。此外，高MELD评分（≥15）和低ΔHR（≤10 bpm）的LTC患者与低MELD评分（10 bpm, HR: 5.54, 95% CI: 3.21-9.53, p）的患者相比，总生存期更差。结论：在这项回顾性队列分析中，LTC表现出较低的血流动力学反应，检测到较低的ΔHR，收缩压和舒张压，以及应激测试中对再adenoson的反应症状较少。血流动力学反应的降低与死亡率显著相关，并且除了MELD评分外，还提供了增加的预后价值。需要进一步的前瞻性研究来验证这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Nuclear Cardiology 医学-核医学

CiteScore

5.30

自引率

20.80%

发文量

249

审稿时长

4-8 weeks

期刊介绍： Journal of Nuclear Cardiology is the only journal in the world devoted to this dynamic and growing subspecialty. Physicians and technologists value the Journal not only for its peer-reviewed articles, but also for its timely discussions about the current and future role of nuclear cardiology. Original articles address all aspects of nuclear cardiology, including interpretation, diagnosis, imaging equipment, and use of radiopharmaceuticals. As the official publication of the American Society of Nuclear Cardiology, the Journal also brings readers the latest information emerging from the Society''s task forces and publishes guidelines and position papers as they are adopted.