Assessment of cardiac risk before aortic reconstruction: Noninvasive work-up using clinical examination, exercise testing, and dobutamine stress echocardiography versus routine coronary arteriography

In this prospective study we evaluated the efficacy of a battery of noninva sive tests including clinical evaluation (CE), exercise testing (ET), and d obutamine stress echocardiography (DSE) for assessment of cardiac risk in 9 0 patients indicated for aortic reconstruction. As the gold standard refere nce technique, coronary arteriography was performed in each patient after n oninvasive evaluation. The sensitivity of CE was low (61%). ET proved to be more sensitive (71.4%) and highly specific (95.8%) but feasibility (77%) a nd diagnostic accuracy (42%) were low. DSE demonstrated acceptable sensitiv ity (78%) and specificity (75.5%) with high feasibility (94.5%) and diagnos tic accuracy (100%). None of the four patients with false negative ET resul ts and only one of seven with false-negative DSE required coronary bypass. On the basis of these findings we conclude that a combination of CE and ET with DES, if necessary, can reliably assess cardiac risk before aortic reco nstruction. Noninvasive assessment is a reliable alternative to routine cor onary arteriography.