Dobutamine stress echocardiography for assessment of perioperative cardiac risk in patients undergoing major vascular surgery.
Why the study?
Does dobutamine stress echocardiography predict perioperative cardiac events in patients undergoing major vascular surgery?
Population
136 patients (mean age 68 years) unable to exercise, scheduled for elective major noncardiac vascular surgery.
Design
Cohort, Echocardiographic images were evaluated by two observers blinded to…
Follow-up
postoperative period
Authors
Discussion
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Implication
Dobutamine stress echocardiography may aid perioperative risk stratification in vascular surgery; leaves open validation in larger prospective cohorts.
Key Points
- To assess the predictive value of preoperative dobutamine stress echocardiography for perioperative cardiac complications in patients undergoing elective major noncardiac vascular surgery.
- Assessed 136 patients (mean age 68 years) unable to exercise prior to elective major vascular surgery using incremental dobutamine infusion (10–40 µg/kg/min) combined with atropine if needed.
- Blinded two echocardiography observers to clinical data and kept test results concealed from perioperative clinical decision-making.
- Analyzed clinical risk profiles (Detsky's modified Goldman score) and stress test results in 131 patients using univariate and multivariate logistic regression.
- A positive dobutamine stress test occurred in 35 of 131 patients, capturing all 15 patients who suffered postoperative cardiac events (5 fatal myocardial infarctions, 9 unstable angina, and 1 pulmonary edema).
- Zero cardiac events occurred in patients with a negative dobutamine stress test (0 of 96 patients).
- Multivariate analysis identified only age > 70 years and new wall motion abnormalities during dobutamine testing as significant independent predictors of perioperative cardiac complications.
Structured PICO
Does dobutamine stress echocardiography predict perioperative cardiac events in patients undergoing major vascular surgery?
P
Population
136 patients (mean age 68 years) unable to exercise, scheduled for elective major noncardiac vascular surgery.
I
Intervention
Dobutamine stress echocardiography (incremental dobutamine infusion 10-40 micrograms/kg/min, with atropine 0.25-1 mg IV if necessary).
O
Outcome
Perioperative cardiac events (myocardial infarction, unstable angina, pulmonary edema, death).composite
Dobutamine stress echocardiography is a highly sensitive predictor of perioperative cardiac events in patients undergoing major vascular surgery.
Cite This Study
Poldermans et al. (1993) studied this question.