|Prognosis of patients with vascular disease after clinical evaluation and dobutamine stress echocardiography.|
|PMID: 10047628 Owner: NLM Status: MEDLINE|
|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 undergoing vascular surgery. METHODS: In 233 patients undergoing vascular procedures, we assessed risk clinically on the basis of Eagle's criteria. Dobutamine echocardiography was performed with a standard protocol and results were classified as showing ischemia, scar, or a normal response. Patients were observed perioperatively, and late follow-up (28 +/- 13 months) was completed in all surgical survivors. A composite end point of cardiac death, myocardial infarction, and unstable 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 events occurred in 8 patients (3%). None of the patients with ischemia had perioperative events, reflecting the effect of revascularization in 9 patients. Late events occurred in 36 patients; ischemia on preoperative stress testing was a predictor of these events even after adjusting for clinical variables and left ventricular dysfunction (relative risk = 3.3; 95% confidence interval 1.6 to 6.8; P =.001). The association of ischemia with clinical predictors was associated with incrementally worse outcome. CONCLUSION: In addition to perioperative assessment, the combined use of clinical and dobutamine echocardiographic evaluation may stratify the risk of late cardiac events.|
|R S Ballal; S Kapadia; M A Secknus; D Rubin; K Arheart; T H Marwick|
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|Type: Journal Article|
|Title: American heart journal Volume: 137 ISSN: 0002-8703 ISO Abbreviation: Am. Heart J. Publication Date: 1999 Mar|
|Created Date: 1999-03-25 Completed Date: 1999-03-25 Revised Date: 2006-02-27|
Medline Journal Info:
|Nlm Unique ID: 0370465 Medline TA: Am Heart J Country: UNITED STATES|
|Languages: eng Pagination: 469-75 Citation Subset: AIM; IM|
|Cleveland Clinic Foundation, Cleveland, OH, USA.|
|APA/MLA Format Download EndNote Download BibTex|
Angina Pectoris / etiology, surgery
Angina, Unstable / etiology, surgery
Cicatrix / ultrasonography
Coronary Disease / diagnosis*, ultrasonography
Death, Sudden, Cardiac / etiology
Dobutamine / diagnostic use*
Heart / drug effects
Myocardial Infarction / etiology, ultrasonography
Myocardial Ischemia / diagnosis, ultrasonography
Vascular Surgical Procedures* / adverse effects
Ventricular Dysfunction, Left / diagnosis
|0/Adrenergic beta-Agonists; 34368-04-2/Dobutamine|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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