Circulation, Vol 87, 1506-1512, Copyright © 1993 by American Heart Association
D Poldermans, PM Fioretti, T Forster, IR Thomson, E Boersma, EM el-Said, NA du Bois, JR Roelandt and H van Urk
BACKGROUND. The purpose of this study was to determine the predictive value
of dobutamine stress echocardiography for perioperative cardiac events in
patients scheduled for elective major noncardiac vascular surgery. METHODS
AND RESULTS. Patients (n = 136; mean age, 68 years) unable to exercise
underwent a dobutamine stress test before surgery (incremental dobutamine
infusion [10-40 micrograms.kg-1.min-1] continued with atropine [0.25-1 mg
i.v.] if necessary to achieve 85% of the age-predicted maximal heart rate
without symptoms or signs of ischemia). The clinical risk profile was
evaluated by Detsky's modification of Goldman's risk factor analysis.
Echocardiographic images were evaluated by two observers blinded to the
clinical data of the patients, and results of the test were not used for
clinical decision making. Technically adequate images were obtained in 134
of 136 patients, one major complication occurred (ventricular
fibrillation), and three tests were discontinued prematurely because of
side effects. Finally, data from 131 patients were analyzed with univariate
and multivariate methods. The dobutamine stress test was positive (new or
worsened wall motion abnormality) in 35 of 131 patients. In the
postoperative period, five patients died of myocardial infarction, nine
patients had unstable angina, and one patient developed pulmonary edema.
All patients with cardiac complications (15 patients) had a positive
dobutamine stress test. No cardiac events occurred in patients with
negative tests. Five patients with a technically inadequate or prematurely
stopped test were operated on without complications. By multivariate
analysis (logistic regression), only age > 70 years and new wall motion
abnormalities during the dobutamine test were significant predictors of
perioperative cardiac events. CONCLUSIONS. Dobutamine stress
echocardiography is a feasible, safe, and useful method for identifying
patients at high or low risk of perioperative cardiac events. The test
yields additional information, beyond that provided by clinical variables,
in patients who are scheduled for major noncardiac vascular surgery.
ARTICLES
Dobutamine stress echocardiography for assessment of perioperative cardiac risk in patients undergoing major vascular surgery
Thoraxcenter, University Hospital Rotterdam-Dijkzigt, The Netherlands.
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