Key result
A positive dobutamine stress echocardiography result was associated with a significantly higher rate of post-operative major adverse cardiac events compared to a negative result (36% vs 4%, OR 14.8889).
Why the study?
Non-invasive functional testing is widely indicated prior to major non-cardiac surgery in patients with reduced exercise capacity, but the accuracy of dobutamine stress echocardiography for preoperative risk stratification required assessment.
Does dobutamine stress echocardiography accurately predict major adverse cardiovascular events in patients with reduced exercise capacity undergoing major non-cardiac surgery?
Observational (n=80)
No
Does dobutamine stress echocardiography accurately predict major adverse cardiovascular events in patients with reduced exercise capacity undergoing major non-cardiac surgery?
Odds Ratio: 14.8889
Absolute Event Rate: 36% vs 4%
p-value: p=0.002
A normal dobutamine stress echocardiogram provides a high negative predictive value (95%) for 30-day postoperative MACE in patients with reduced exercise capacity undergoing major non-cardiac surgery.
Background: Before major non cardiac surgeries, non-invasive functional testing widely indicated for evaluating patients with reduced exercise capacity. Aim: To assess the accuracy of dobutamine stress echocardiography (DSE) for risk stratification prior to major non-cardiac surgeries.Methods: Eighty patients hospitalized for major non-cardiac surgeries underwent DSE and were reviewed to determine major adverse cardiac events (MACE) up to 30 days post-discharge.Results: Out of 80 DSE performed for preoperative risk stratification, 12.5% were positive and 87.5% were negative.Postoperative MACE in the DSE +ve group was 36% compared to 4% in the DSE-ve group (OR = 14.8889, p = 0.002).Based on the MACE rates, the overall sensitivity of DSE was 56%, specificity was 90%, and positive predictive value (PPV) was only 36% while negative predictive value (NPV) was 95%.The admission for ICU and total days of hospital stay post surgery was comparable in both groups (p = 0.177).Conclusion: DSE for preoperative risk stratification had a high clinical utility in patients undergoing major non-cardiac surgery.In particular, a normal DSE had a high negative predictive value for post-operative MACE up to 30 days post discharge.Positive DSE did not correlate with the admission for ICU or total days of hospital stay post major non cardiac surgery.
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Tabl et al. (2020) conducted an observational in Reduced exercise capacity and multiple cardiac risk factors prior to major non-cardiac surgery (n=80). Positive Dobutamine Stress Echocardiography (DSE) vs. Negative DSE was evaluated on Major adverse cardiac events (MACE) up to 30 days post-discharge (OR 14.8889, p=0.002). A positive dobutamine stress echocardiography result was associated with a significantly higher rate of post-operative major adverse cardiac events compared to a negative result (36% vs 4%, OR 14.8889).
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