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Preoperative Dobutamine Stress Echocardiography and Clinical Factors for Assessment of Cardiac Risk after Noncardiac Surgery.
Cullen, Michael W; McCully, Robert B; Widmer, R Jay; Schroeder, Darrell R; Salonen, Bradley R; Raslau, David; Sundsted, Karna K; Mohabbat, Arya B; Dougan, Brian M; Bierle, Dennis M; Widmer, Andrew; Banerjee, Dipti; Gaba, Prakriti; Tellez, Rene; Kane, Garvan C; Pellikka, Patricia A; Mauck, Karen F.
Afiliación
  • Cullen MW; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: cullen.michael@mayo.edu.
  • McCully RB; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
  • Widmer RJ; Division of Cardiology, Baylor Scott & White Medical Center, Temple, Texas.
  • Schroeder DR; Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
  • Salonen BR; Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.
  • Raslau D; Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.
  • Sundsted KK; Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.
  • Mohabbat AB; Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.
  • Dougan BM; Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.
  • Bierle DM; Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.
  • Widmer A; Division of General Internal Medicine, Baylor Scott & White Medical Center, Temple, Texas.
  • Banerjee D; Department of Obstetrics & Gynecology, University of California, Los Angeles, Los Angeles, California.
  • Gaba P; Department of Internal Medicine, Columbia University Medical Center, New York, New York.
  • Tellez R; Department of Surgery, University of California, Irvine, Orange, California.
  • Kane GC; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
  • Pellikka PA; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
  • Mauck KF; Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.
J Am Soc Echocardiogr ; 33(4): 423-432, 2020 04.
Article en En | MEDLINE | ID: mdl-32089383
BACKGROUND: The role of dobutamine stress echocardiography (DSE) in the risk stratification of patients undergoing noncardiac surgery in the current era is unclear. The aim of this study was to evaluate the yield of DSE and the additive role of DSE to clinical criteria for preoperative risk stratification of patients undergoing noncardiac surgery. METHODS: The study included 4,494 patients undergoing DSE ≤90 days before noncardiac surgery. The primary outcome was a composite of postoperative myocardial infarction, cardiac arrest, and all-cause mortality ≤30 days after noncardiac surgery. RESULTS: The overall 30-day postoperative cardiac event rate was 2.3%. The mortality rate was 0.9% overall and 0.7% and 1.3% after normal and abnormal results on DSE, respectively. Among clinical variables, the modified Revised Cardiac Risk Index score demonstrated the strongest association with postoperative risk (P < .001). Patients with Revised Cardiac Risk Index scores of ≥3 had an event rate of 7.5%. The event rates for patients with wall motion score index ≥1.7 at baseline, left ventricular ejection fractions <40% at peak stress, or ischemic thresholds <70% of age-predicted maximal heart rate were 7.1%, 8.6%, and 7.9%, respectively. After adjusting for clinical variables, the overall result of DSE (P < .001), baseline and peak-stress wall motion score index (P < .001 and P = .014, respectively), peak-stress left ventricular ejection fraction (P < .001), and the number of ischemic segments (P = .027) were all associated with postoperative cardiac events. Incremental multivariate analysis demonstrated that an overall abnormal result on DSE, added to clinical variables, was associated with an increased risk for postoperative cardiac events (odds ratio, 2.07; 95% CI, 1.35-3.17; P < .001). CONCLUSIONS: Baseline and peak-stress findings on preoperative DSE add to the prognostic utility of clinical variables for stratifying cardiac risk after noncardiac surgery.
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Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Ecocardiografía de Estrés / Infarto del Miocardio Tipo de estudio: Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: J Am Soc Echocardiogr Asunto de la revista: DIAGNOSTICO POR IMAGEM Año: 2020 Tipo del documento: Article

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Ecocardiografía de Estrés / Infarto del Miocardio Tipo de estudio: Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: J Am Soc Echocardiogr Asunto de la revista: DIAGNOSTICO POR IMAGEM Año: 2020 Tipo del documento: Article