EVALUATION OF CARDIAC RISK BEFORE VASCULAR-SURGERY BY DOBUTAMINE STRESS ECHOCARDIOGRAPHY

The detection of coronary artery disease is essential before abdominal aortic surgery. In view of the limitations of the usual methods of in vestigation, dobutamine stress echocardiography was assessed in this i ndication. Eighty-five patients with an aorticabdominal aneurysm or ob structive arterial disease underwent dobutamine stress echocardiograph y followed by coronary angiography. Depending on the results, vascular surgery was performed directly, after myocardial revascularisation or not at all. Significant coronary lesions (stenosis greater than or eq ual to 50 %) were found in 32 of the 85 patients (38 %). Dobutamine st ress echocardiography had a sensitivity of 78 % and a specificity of 7 5 %, and positive and negative predictive values of 66 and 85 % respec tively. The relative risk of coronary disease was 4.4. In this series, 15 patients had severe coronary lesions : 2 were turned down for surg ery and 13 underwent myocardial revascularisation; 14 of them (93 %) h ad a positive stress echo. The only 2 non-fatal cardiac complications of peripheral surgery (3 %) occurred after a positive dobutamine stres s echo. This study confirms both the necessity of preoperative assessm ent of coronary risk and the efficacy of dobutamine stress echocardiog raphy in this indication. Dobutamine stress echocardiography is reliab le, noninvasive, economical and a real alternative to isotopic methods . Its good predictive value justifies using coronary angiography only for patients with a positive result.