DOBUTAMINE STRESS ECHOCARDIOGRAPHY FOR ASSESSMENT OF PERIOPERATIVE CARDIAC RISK IN PATIENTS UNDERGOING MAJOR VASCULAR-SURGERY

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 su rgery. Methods and Results. Patients (n = 136; mean age, 68 years) una ble to exercise underwent a dobutamine stress test before surgery (inc remental dobutamine infusion [10-40 mug . kg-1 . min-1] continued with atropine [0.25-1 mg i.v.] if necessary to achieve 85% of the age-pred icted maximal heart rate without symptoms or signs of ischemia). The c linical risk profile was evaluated by Detsky's modification of Goldman 's risk factor analysis. Echocardiographic images were evaluated by tw o observers blinded to the clinical data of the patients, and results of the test were not used for clinical decision making. Technically ad equate images were obtained in 134 of 136 patients, one major complica tion occurred (ventricular fibrillation), and three tests were discont inued prematurely because of side effects. Finally, data from 131 pati ents were analyzed with univariate and multivariate methods. The dobut amine stress test was positive (new or worsened wall motion abnormalit y) in 35 of 131 patients. In the postoperative period, five patients d ied or myocardial infarction, nine patients had unstable angina, and o ne patient developed pulmonary edema. All patients with cardiac compli cations (15 patients) had a positive dobutamine stress test. No cardia c 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 dobut amine 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 per ioperative cardiac events. The test yields additional information, bey ond that provided by clinical variables, in patients who are scheduled for major noncardiac vascular surgery.