Background: The blunted ventricular responses to stress in liver cirrhosis (LC) are associated postoperative mortality after major surgery or liver transplantation. But, the objective evaluation method for cardiovascular response to stress in LC is not present. This study was designed to examine the feasibility of dobutamine stress echocardiography (DSE) for the evaluation of blunted chronotrophic and inotropic response in advanced LC. Methods: We enrolled consecutive stable 71 advanced LC patients with normal LV function. The LV systolic and diastolic functions were evaluated by echocardiography at rest and peak dobutamine infusion (40μg/kg/min). LV ejection fraction (LVEF), LV end-diastolic volume (LVEDV) and end-systolic volume (LVESV) were measured by modified Simpson’s method. Abnormal volume and LVEF response defined as a less than 10% decrease in ΔLVEDV, 20% decrease in ΔLVESV and 10% increase in ΔEF at peak dobutamine infusion by previous criteria. We measured chronotrophic response by heart rate (HR) reserve [(peak HR - HR at rest)/(220 – age - HR at rest)] x 100). Results: Abnormal response was occurred in 18 cases (25.4 %) without regional wall motion abnormalities. The baseline demographic characteristics were similar between the two groups except lower Child-Pugh score (6.4 ± 1.6 vs. 7.5 ± 1.5., p=0.01) in abnormal response group. At baseline echocardiography, there were significant lower resting pulse rate (68.4 ± 12.4 vs. 78.1 ± 14.9, p=0.01) and higher LVEF (71.5 ± 7.0 vs. 66.3 ± 8.5, p=0.02) in abnormal response group. At peak dobutamine infusion, there were significantly decreased in ΔLVEF (-2.3 ± 8.3 vs. 24.8 ± 15.9%, p <0.01) , increased in ΔLVEDV (12.4 ± 15.3 vs. -23.6 ± 15.1%, p <0.01) and ΔLVESV (19.9 ± 26.3 vs. -52.9 ± 31.5%, p <0.01) in abnormal group. The heart rate reserve (1.7 ± 13.6 vs. 65.2 ± 80.0%, p <0.01) were also significantly lower in abnormal response group than normal group. Conclusions: Twenty five percent in patients with advanced LC showed blunted inotropic and chronotrophic response. Our results suggested DSE might be a useful and safe modality for the evaluation of blunted chronotrophic and inotropic response in advanced LC.
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