Preoperative Dobutamine Stress Echocardiography and Clinical Factors for Assessment of Cardiac Risk after Noncardiac Surgery - 02/04/20
, Robert B. McCully, MD a, R. Jay Widmer, MD, PhD b, Darrell R. Schroeder, MS c, Bradley R. Salonen, MD d, David Raslau, MD, MPH d, Karna K. Sundsted, MD d, Arya B. Mohabbat, MD d, Brian M. Dougan, MD d, Dennis M. Bierle, MD d, Andrew Widmer, MD, MPH e, Dipti Banerjee, MD, MPH f, Prakriti Gaba, MD g, Rene Tellez, MD, MBA h, Garvan C. Kane, MD, PhD a, Patricia A. Pellikka, MD a, Karen F. Mauck, MD dAbstract |
Background |
The role of dobutamine stress echocardiography (DSE) in the risk stratification of patients undergoing noncardiac surgery in the current era is unclear. The aim of this study was to evaluate the yield of DSE and the additive role of DSE to clinical criteria for preoperative risk stratification of patients undergoing noncardiac surgery.
Methods |
The study included 4,494 patients undergoing DSE ≤90 days before noncardiac surgery. The primary outcome was a composite of postoperative myocardial infarction, cardiac arrest, and all-cause mortality ≤30 days after noncardiac surgery.
Results |
The overall 30-day postoperative cardiac event rate was 2.3%. The mortality rate was 0.9% overall and 0.7% and 1.3% after normal and abnormal results on DSE, respectively. Among clinical variables, the modified Revised Cardiac Risk Index score demonstrated the strongest association with postoperative risk (P < .001). Patients with Revised Cardiac Risk Index scores of ≥3 had an event rate of 7.5%. The event rates for patients with wall motion score index ≥1.7 at baseline, left ventricular ejection fractions <40% at peak stress, or ischemic thresholds <70% of age-predicted maximal heart rate were 7.1%, 8.6%, and 7.9%, respectively. After adjusting for clinical variables, the overall result of DSE (P < .001), baseline and peak-stress wall motion score index (P < .001 and P = .014, respectively), peak-stress left ventricular ejection fraction (P < .001), and the number of ischemic segments (P = .027) were all associated with postoperative cardiac events. Incremental multivariate analysis demonstrated that an overall abnormal result on DSE, added to clinical variables, was associated with an increased risk for postoperative cardiac events (odds ratio, 2.07; 95% CI, 1.35–3.17; P < .001).
Conclusions |
Baseline and peak-stress findings on preoperative DSE add to the prognostic utility of clinical variables for stratifying cardiac risk after noncardiac surgery.
Le texte complet de cet article est disponible en PDF.Highlights |
• | This study included 4,494 patients undergoing DSE prior to noncardiac surgery. |
• | The overall 30-day postoperative rate of adverse cardiac events was 2.3%. |
• | Baseline and stress-induced DSE abnormalities were associated with adverse events. |
• | An overall abnormal DSE was incrementally associated with adverse events. |
• | DSE remains part of a stepwise approach to perioperative cardiac assessment. |
Keywords : Dobutamine stress echocardiography, Noncardiac surgery, Preoperative evaluation
Abbreviations : APMHR, DSE, LV, LVEF, MET, RCRI, WMA, WMSI
Plan
| Conflicts of Interest: None. |
Vol 33 - N° 4
P. 423-432 - avril 2020 Retour au numéro
Article précédent
- Recommendations for Echocardiography Laboratories Participating in Cardiac Point of Care Cardiac Ultrasound (POCUS) and Critical Care Echocardiography Training: Report from the American Society of Echocardiography
- James N. Kirkpatrick, Richard Grimm, Amer M. Johri, Bruce J. Kimura, Smadar Kort, Arthur J. Labovitz, Michael Lanspa, Sue Phillip, Samreen Raza, Kelly Thorson, Joel Turner
- A Reappraisal of Dobutamine Echocardiography for Risk Stratification before Noncardiac Surgery
- Stephen G. Sawada
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?