Abstract Body (Do not enter title and authors here): Background: Dobutamine stress echocardiography (DSE) is a frequently used tool in cardiovascular (CV) risk assessment of liver transplantation (LT) candidates. Its prognostic value compared to traditional cardiac risk stratification remains unclear.

Research question: How does the prognostic value of pre-transplant DSE in LT candidates compare to the revised cardiac risk index (RCRI)?

Aim: Compare DSE’s prognostic value to RCRI in LT patients and analyze post-transplant CV outcomes.

Methods: This single-center study included adult patients undergoing pre-transplant DSE as part of LT evaluation from 2008-2021. DSE were categorized as positive, negative, or inadequate. Primary outcomes were post-operative ischemic cardiac events and mortality, with secondary outcome of transplant delays from inadequate DSE. Mann-Whitney U and Fischer’s exact tests compared variables; logistic regression assessed RCRI and DSE for 30-day mortality and cardiac events.

Results: Of 981 LT candidates, 644 (66%) had pre-transplant DSE with minimum 2-year follow-up. Average age was 57 ± 7 years, with 33% women. Four and eleven patients experienced cardiac events and mortality <30 days post-transplant, none of whom had positive pre-LT DSE. Six DSE exhibited inducible ischemia, with one revealing obstructive coronary artery disease on invasive assessment. DSE was inadequate in 113 patients (18%), with 34 (30%) undergoing further cardiac evaluation on average 33.8 days later (Table 2). Logistic regression showed a c-statistic of 0.52 for RCRI>1 (p-value 0.50), 0.51 for DSE (p-value 0.82), and 0.52 for RCRI>1 and DSE combined (p-value 0.80) in predicting 30-day mortality and cardiac events.

Conclusion: Our study demonstrates limited prognostic value of DSE above RCRI score alone for predicting post-transplant mortality. Inadequate DSE was frequent and extended LT wait times. Further research is necessary to define clinically relevant subgroups and refine CV risk assessment in LT candidates.