J Korean Soc Echocardiogr.  1996 Jul;4(1):22-28. 10.4250/jkse.1996.4.1.22.

Usefulness of Dobutamine Stress Echocardiography for Assessment of cardiac Risk before Noncardiac Surgery

• Kang HS
• Choue CW
• Kim KS
• Kim MS
• Song JS
• Bae JH

• KMID: 2410402
• DOI: http://doi.org/10.4250/jkse.1996.4.1.22

Abstract

BACKGROUND
Two-dimensional echocardiography performed during incremental infusion of dobutamine has been shown to be a safe and accurate method for detection of coronary artery disease in patients who are unable to undergo conventional exercise testing. A significant proportion of these patients are referred for evaluation before undergoing noncardiac surgery. METHOD: To assess the value of dobutamine stress echocardiography(DSE), for assessment of preoperative cardiac risk, 88 patients (male : 32, female : 56, mean age : 60 years) were evaluated. patients records were reviewed to determine the short-term outcome of surgery. significant cardiac events were defined as unstable angina, myocardial infarction and sudden cardiac death occurred before discharge. Intravenous dobutamine was infused in a graded fashion (10 to 45µg/kg/min in 3 minutes stages), with two-dimensional echocardiographic monitoring of segmental wall motion of left ventricle.
RESULTS
1) The major reasons underwent dobutamine stress echocardiography were abnormalities of ECG such as ST-T changes, abnormal Q wave(65% : 64 of 98 patients) and history of coronary artery disease(29% : 28 of 98 patients). 2) Of the 88 patients who underwent noncardiac surgery, 85(97%) patients were negative response in dobutamine stress echocardiography, and no patients had cardiac events, also 3(3%) patients who had positve response did not occur cardiac events. 3) No major adverse effects occurred with stress test in any patient.
CONCLUSION
These results suggest that DSE is useful preoperative diagnostic method for predicting short-term surgical outcome in patients with suspicous coronary artery disease undergoing noncardiac surgery.

Keyword

Dobutamine stress echocardiography; Preoperative cardiac risk; Noncardiac surgery

MeSH Terms

Angina, Unstable
Coronary Artery Disease
Coronary Vessels
Death, Sudden, Cardiac
Dobutamine*
Echocardiography
Echocardiography, Stress*
Electrocardiography
Exercise Test
Female
Heart Ventricles
Humans
Methods
Myocardial Infarction
Dobutamine

Reference

References

1). Manga no DT. Perioperative cardiac morbidity. Anesthesiology. 72:53–84. 1990.

2). Abraham SA, Coles NA, Coley CM, Strauss HW, Boucher CA, Eagle KA. Coronary risk of non-cardiac surgery. Pro Cardiac Dis. 34(3):205–234. 1991.

3). Drips RD, Lamont A, Eckenhoff JE. The role of anesthesia in surgical mortality. JAMA. 178:261–266. 1961.

4). Goldman L, Caldera DL, Nussbaum SR. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 297:845–50. 1977.

5). Zeldin RA. Assessing cardiac risk in patients who undergo noncardiac surgical procedures. Can J Surg. 27:402–4. 1984.

6). Larsen SF, Olesen KH, Jacobsen E. Prediction of cardiac risk in noncardiac surgery. Er Heart J. 8:179–85. 1987.

7). Detsky AS, Abrams HB, McLaughlin JR. Predicting cardiac complications in patients undergoing noncardiac surgery. J Gen Intern Med. 1(21):1–9. 1986.

8). Cutler BS, Wheeler HB, Paraskos JA, Cardullo PA. Applicability and interpretation of electrocardiographic stress testing in patients with peripheral vascular disease. Am J Surg. 141:501–6. 1981.

9). Ruby KE, Goldman L, Creager MA. Correlation between preoperative ischemia and major cardiac events after peripheral vascular surgery. N Engl J Med. 321:1296–300. 1989.

10). Mangano DT, Browner WS, Hollenberg M. Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. N Engl J Med. 323:1781–1788. 1990.

11). Poldermans D, Arnese M, Fioretti PM. Improved cardiac risk stratification in major vascular surgery with dobutamine-atropine stress echocardiography. J Am Coll Cardiol. 26:648–53. 1995.

12). Langan EM, Youkey JR, Franklin DP, Elmore JR, Costello JM, Nassef LA. Dobutamine stress echocardiography for cardiac risk assessment before aortic surgery. J Vasc Surg. 18:905–13. 1993.

13). Tischler MD, Lee TH, Hirsch AT. Prediction of major cardiac events after peripheral vascular surgery using dipyridamole echocardiography. Am J Cardiol. 68:593–597. 1991.

14). Pasternack PF, Imparato AM, Bear G. The value of radionuclide angiography as a predictor of perioperative myocardial infarction in patients undergoing abdominal aortic aneurysm resection. J Vasc Surg. 1:320–325. 1984.

15). Botcher CA, Brewster DC, Darling RC, Okada RD, Strauss HW, Pohost GM. Determination of cardiac risk by dipyridamole-thallium imaging before peripheral vascular surgery. N Engl J Med. 312:389–94. 1985.

16). Cutler BS, Leppo JA. Dipyridamole-thallium 201 scintigraphy to detect coronary artery disease before abdominal aortic surgery. J Vasc Surg. 5:91–100. 1987.

17). Topkins MJ, Artusio JF. Myocardial infarction and surgery. Anesth Analg. 43:716–720. 1964.

18). Tarhan S, MotFitt EA, Taylor WF. Myocardial infarction after general anesthesia. JAMA. 220:1451–1454. 1972.

19). Steen PA, Tinker JH, Tarhan S. Myocardial reinfarction after anesthesia and surgery. JAMA. 239:2566–2570. 1978.

20). von Knorring J. Postoperative myocardial infarction: prospective study in a risk group of surgical patients. Surgery. 90:55–60. 1981.

21). Arkins R, Smessaert A A, Hicks RG. Mortality and morbidity in surgical patients with coronary artery disease. JAMA. 190:485–488. 1964.

22). Jeffrey CC, Kinsman J, Cullen DJ. A prospective evaluation of cardiac risk index. Anesthesiology. 58:462–464. 1983.

23). McCann RL, Clements FM. Silent myocardial ischemia in patients undergoing peripheral vascular surgery: Incidence and association with perioperative cardiac morbidity and mortality. J Vasc Surg. 9:583–587. 1989.

24). Pasternak PF, Imparato AM, Riles TS. The value of the radionuclide angiogram in the prediction of perioperative myocardial infarction in patients undergoing lower extremity revascularization procedures. Circulation. 72:11–13. 1985; (supply).

25). Goldman L, Caldera DL, Southwick FS. Cardiac risk factors and complications in non-cardiac surgery. Medicine. 57:357–370. 1978.

26). Becker RC, Underwood DA. Myocardial infarction in patients undergoing noncardiac surgery. Cleve Clin J Med. 54:25–28. 1987.

27). Jeffrey CC, Kunsman J, Cullen DJ, Brewster DC. A prospective evaluation of cardiac risk index. Anesthesiology. 58:462–464. 1983.

28). Wang T, Detsky AS. Preoperative cardiac risk assessment for patients having peripheral vascular surgery. Ann Intern Med. 116:743–753. 1992.

29). McPhail N, Calvin JE, Shariatmadar A, Barber GG, Scobie TK. The use of preoperative exercise testing to predict cardiac complications after arterial reconstruction. J Vasc Surg. 7:60–68. 1988.

30). Golden MA, Whittemore AD, Donaldson MC, Mannick JA. Selective evaluation and management of coronary artery disease in patients undergoing repair of abdominal aortic aneurysms: a 16-year experience. Ann Surg. 212:415–423. 1990.

31). Person MC, Hurst JM, Hertzberg VS. Cardiac prognosis in noncardiac geriatric surgery. Ann Intern Med. 103:832–837. 1985.

32). Person MC, Hurst JM, Hertzber VS, Baughman R, Rouan GW, Ellis K. Prediction of cardiac and pulmonary complications related to elective abdominal and non-cardiac thoracic surgery in geriatric patients. Am J Med. 88:101–107. 1990.

33). Carliner NH, Fisher ML, Plotnick GD. Routine preoperative exercise testing in patients undergoing major non cardiac surgery. Am J Cardiol. 56:51–58. 1985.

34). Pasternack PF, Grossi EA, Baumann G. The value of silent myocardial ischemia monitoring in the prediction of perioperative myocardial infarction in patients undergoing peripheral vascular surgery. J Vasc Surg. 10:617–625. 1989.

35). Ouyang P, Gerstenblith G, Furman WR, Golueke PJ, Gottlieb SO. Frequency and significance of early postoperative silent myocardial ischemia in patients having peripheral vascular surgery. Am J Cardiol. 64:1113–1116. 1989.

36). Kazmers A, Cerqueira MD, Zierler RE. Perioperative and late outcome in patients with left ventricular ejection fraction of 35% or less who require major vascular surgery. J Vasc Surg. 8:307–15. 1988.

37). Hendel RC, Whitfield SS, Villegas BJ, Cutler BS, Leppo JA. Prediction of late cardiac events by dipyridamole thallium imaging in patients undergoing elective vascular surgery. Am J Cardiol. 70:1243–1249. 1992.

38). Eagle KA, Coley CM, Newell JB. Combining clinical and thallium data optimizes preoperative assessment of cardiac risk before major vascular surgery. Ann Intern Med. 110:859–66. 1989.

39). Brown KA, Rowen M. Extent of jeopardized viable myocardium determined by myocardial perfusion imaging best predicts perioperative cardiac events in patients undergoing noncardiac surgery. J Am Coll Cardiol. 21:325–323. 1993.

40). Lotte J, Waters D. Czarina M, Picard M, Champagne P, Lapointe J. Preoperative coronary artery disease risk stratification based on dipyridamole imaging and a simple three-step, three-segment model for patients undergoing noncardiac vascular surgery or major general surgery. Am J Cardiol. 69:1553–1558. 1992.

41). Baron JF, Mundler O, Bertrand M. Dipyridamolethallium scintigraphy and gated radionuclide angiography to assess cardiac risk before abdominal aortic surgery. N Engl J Med. 330:663–669. 1994.