Dobutamine stress echocardiography for the preoperative evaluation of patients undergoing lung volume reduction surgery

Background: Lung volume reduction surgery has been proposed as a bridge to lung transplantation and as definitive therapy for advanced chronic obstruc tive lung disease. However, patient selection criteria and optimal preopera tive assessment have not been clearly defined. Objective: We investigated t he feasibility, safety, and value of dobutamine stress echocardiography as a predictor of major early cardiac events in patients who underwent lung vo lume reduction surgery. Methods: The study population consisted of 46 patie nts (21 men and 25 women, mean age 59 +/- 9 years) who underwent dobutamine stress echocardiography (maximun dose 40 mu g.kg(-1).min(-1) plus atropine if needed) 180 days or less before lung volume reduction surgery. Adverse cardiac events were prospectively defined and tabulated during hospitalizat ion after the operation and at subsequent outpatient visits, Results: Dobut amine stress :echocardiography was interpretable in 45 of 46 (98%) patients , There were no adverse events during testing,The studies revealed normal l eft ventricular systolic function at rest in all patients and normal right ventricular function in all patients but one. Thirteen patients had right v entricular enlargement. Estimated right ventricular systolic pressure was m ildly elevated (>40 mn Hg) in 5 patients. Four patients (9%) had stress tes ts positive for ischemia, There were no perioperative deaths. Follow-np was available for 44 of 45 patients at a duration of 20.0 +/- 7.0 months. Two major adverse cardiac events occurred in the same patient in whom the resul ts of dobutamine stress echocardiography were positive for ischemia (positi ve predictive value 25%, 95% confidence interval 0% to 83%; negative predic tive value 100%, 95% confidence interval 90 to 100%), Conclusion: Despite e nd-stage chronic obstructive lung disease and poor ultrasound windows, dobu tamine stress echocardiography is feasible and safe in patients undergoing evaluation for lung volume reduction surgery, It yields important informati on on right and left ventricular function and has an excellent negative pre dictive value for early and late adverse cardiac events.