Ibolya Csecs, Aakanksha Sharma, Vandana Khungar, Albert J Sinusas, Stephen Possick, Edward J Miller, Attila Feher
{"title":"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。","authors":"Ibolya Csecs, Aakanksha Sharma, Vandana Khungar, Albert J Sinusas, Stephen Possick, Edward J Miller, Attila Feher","doi":"10.1016/j.nuclcard.2025.102454","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>We conducted a retrospective study of LTCs who underwent regadenoson nuclear stress testing with either <sup>99m</sup>Tc-tetrofosmin single-photon emission computed tomography (SPECT; N = 224) or <sup>82</sup>Rubidium 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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":" ","pages":"102454"},"PeriodicalIF":2.7000,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Blunted hemodynamic response to pharmacological stress is predictive of mortality in liver transplant candidates.\",\"authors\":\"Ibolya Csecs, Aakanksha Sharma, Vandana Khungar, Albert J Sinusas, Stephen Possick, Edward J Miller, Attila Feher\",\"doi\":\"10.1016/j.nuclcard.2025.102454\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>We conducted a retrospective study of LTCs who underwent regadenoson nuclear stress testing with either <sup>99m</sup>Tc-tetrofosmin single-photon emission computed tomography (SPECT; N = 224) or <sup>82</sup>Rubidium 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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":16476,\"journal\":{\"name\":\"Journal of Nuclear Cardiology\",\"volume\":\" \",\"pages\":\"102454\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2025-08-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Nuclear Cardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.nuclcard.2025.102454\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Nuclear Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.nuclcard.2025.102454","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Blunted hemodynamic response to pharmacological stress is predictive of mortality in liver transplant candidates.
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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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.
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