P266Noninvasive estimation of pulmonary vascular resistance during transthoracic echocardiography and dobutamine stress echocardiography in patients before orthotopic liver transplantation


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Abstract

Aim: The aim of this study is to investigate pulmonary vascular resistance response to dobutamine stress testing in patients with end-stage liver disease.Methods: We followed 54 patients (34 men and 20 women, aged 19 to 63 years, mean 51,9) undergoing evaluation for orthotopic liver transplantation. In all patients was diagnosed liver cirrhosis. Four of them were evaluated for re-transplantation. Transthoracic echocardiography and dobutamine stress echocardiography was performed in all patients. Estimation of pulmonary vascular resistance was performed in all patients at rest and at peak dose of dobutamine. We have used an equation for noninvasive calculation of PVR : PVR (WU)=10xTRV/TVI RVOT.Results: An average peak dose of 39 (SD 6,9) micrograms/kg/min dobutamine was given. 49 (90,7%) patients reached 85% maximum heart rate. An average tricuspid regurgitant velocity (TRV) at rest was 2,5 m/s (SD 0,3) and at peak dose of dobutamine was 2,7 m/s (SD 0,4) and an average right ventricular tract time velocity integral (TVI RVOT) was 19,6 cm (SD 3,3) and 24,6 cm (SD 4,9) respectively. The average pulmonary vascular resistance (PVR) measured at rest was 1,3 Woods units (SD 0,3) and at peak dose of dobutamine was 1,1 Woods units (SD 0,3). PVR estimated by echocardiography decreased significantly (p<0,001).Conclusions: Dobutamine infusion leads to peripheral vasodilatation and an increase in cardiac output. Our data indicated that pulmonary vascular resistance decreased during dobutamine infusion in patients with end-stage liver disease.

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