Document Detail

Prognosis of patients with vascular disease after clinical evaluation and dobutamine stress echocardiography.
MedLine Citation:
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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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  137     ISSN:  0002-8703     ISO Abbreviation:  Am. Heart J.     Publication Date:  1999 Mar 
Date Detail:
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    
Other Details:
Languages:  eng     Pagination:  469-75     Citation Subset:  AIM; IM    
Cleveland Clinic Foundation, Cleveland, OH, USA.
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MeSH Terms
Adrenergic beta-Agonists / diagnostic use*
Angina Pectoris / etiology,  surgery
Angina, Unstable / etiology,  surgery
Cicatrix / ultrasonography
Confidence Intervals
Coronary Disease / diagnosis*,  ultrasonography
Death, Sudden, Cardiac / etiology
Dobutamine / diagnostic use*
Follow-Up Studies
Heart / drug effects
Multivariate Analysis
Myocardial Infarction / etiology,  ultrasonography
Myocardial Ischemia / diagnosis,  ultrasonography
Myocardial Revascularization
Prospective Studies
Risk Assessment
Risk Factors
Survival Rate
Treatment Outcome
Vascular Surgical Procedures* / adverse effects
Ventricular Dysfunction, Left / diagnosis
Reg. No./Substance:
0/Adrenergic beta-Agonists; 34368-04-2/Dobutamine

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