Rs. Ballal et al., Prognosis of patients with vascular disease after clinical evaluation and dobutamine stress echocardiography, AM HEART J, 137(3), 1999, pp. 469-475
Citations number
22
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
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 und
ergoing vascular surgery.
Methods In 233 patients undergoing vascular procedures, we assessed risk cl
inically on the basis of Eagle's criteria. Dobutamine echocardiography was
performed with a standard protocol and results were classified as showing i
schemia, scar, or a normal response. Patients were observed perioperatively
, and late follow-up (28 +/- 13 months) was completed in all surgical survi
vors. A composite end point of cardiac death, myocardial infarction, and un
stable 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 even
ts occurred in 8 patients (3%). None of the patients with ischemia had peri
operative events, reflecting the effect of revascularization in 9 patients.
late events occurred in 36 patients; ischemia on preoperative stress testi
ng was a predictor of these events even after adjusting for clinical variab
les and left ventricular dysfunction (relative risk = 3.3; 95% confidence i
nterval 1.6 to 6.8; P = .001). The association of ischemia with clinical pr
edictors was associated with incrementally worse outcome.
Conclusion In addition to perioperative assessment, the combined use of cli
nical and dobutamine echocardiographic evaluation may stratify the risk of
late cardiac events.