Prognosis of patients with vascular disease after clinical evaluation and dobutamine stress echocardiography.

Abstract

BACKGROUND:

Coronary disease is an important cause of long-term morbidity in patients needing major vascular surgery. We sought to assess the efficacy of preoperative clinical evaluation and the detection of inducible ischemia for prediction of immediate and long-term cardiac outcomes of patients undergoing vascular surgery.

METHODS:

In 233 patients undergoing vascular procedures, we assessed risk clinically on the basis of Eagle's criteria. Dobutamine echocardiography was performed with a standard protocol and results were classified as showing ischemia, scar, or a normal response. Patients were observed perioperatively, and late follow-up (28 +/- 13 months) was completed in all surgical survivors. A composite end point of cardiac death, myocardial infarction, and unstable and progressive angina requiring late revascularization was used to judge event-free survival.

RESULTS:

Of 233 patients undergoing preoperative dobutamine echocardiography, 39 (17%) had inducible ischemia and 36 (15%) had scar. Perioperative events occurred in 8 patients (3%). None of the patients with ischemia had perioperative events, reflecting the effect of revascularization in 9 patients. Late events occurred in 36 patients; ischemia on preoperative stress testing was a predictor of these events even after adjusting for clinical variables and left ventricular dysfunction (relative risk = 3.3; 95% confidence interval 1.6 to 6.8; P =.001). The association of ischemia with clinical predictors was associated with incrementally worse outcome.

CONCLUSION:

In addition to perioperative assessment, the combined use of clinical and dobutamine echocardiographic evaluation may stratify the risk of late cardiac events.

• Authors: R S Ballal, S Kapadia, M A Secknus, D Rubin, K Arheart, T H Marwick
• Journal: American heart journal (Am Heart J) Vol. 137 Issue 3 Pg. 469-75 (Mar 1999) ISSN: 0002-8703 [Print] United States
• PMID: 10047628 (Publication Type: Journal Article)

Chemical References

• Adrenergic beta-Agonists
• Dobutamine

Topics

• Adrenergic beta-Agonists
• Aged
• Angina Pectoris (etiology, surgery)
• Angina, Unstable (etiology, surgery)
• Cicatrix (diagnostic imaging)
• Confidence Intervals
• Coronary Disease (diagnosis, diagnostic imaging)
• Death, Sudden, Cardiac (etiology)
• Dobutamine
• Echocardiography
• Female
• Follow-Up Studies
• Forecasting
• Heart (drug effects)
• Humans
• Male
• Multivariate Analysis
• Myocardial Infarction (diagnostic imaging, etiology)
• Myocardial Ischemia (diagnosis, diagnostic imaging)
• Myocardial Revascularization
• Prognosis
• Prospective Studies
• Risk Assessment
• Risk Factors
• Survival Rate
• Treatment Outcome
• Vascular Surgical Procedures (adverse effects)
• Ventricular Dysfunction, Left (diagnosis)