title: Safety of performing dobutamine stress echocardiography in patients with abdominal aortic aneurysm > or = 4 cm in diameter.
abstract: Dobutamine stress echocardiography is frequently used for preoperative assessment of cardiac risk before major vascular surgical procedures. Dobutamine increases myocardial contractility, heart rate, and rate of increase of left ventricular pressure and has a variable effect on blood pressure. These effects could potentially increase the likelihood of rupture of a vascular aneurysm. The safety of performing dobutamine stress echocardiography in patients with vascular aneurysms has not been adequately addressed. Of 1,968 consecutive patients who underwent dobutamine stress echocardiography at our institution, 98 patients with abdominal aortic aneurysms > or = 4 cm in diameter were identified. Records were reviewed to determine whether there was any evidence of aneurysm rupture or adverse vascular events as a result of the stress test. There was no case of aneurysm rupture or hemodynamic instability precipitated by dobutamine stress echocardiography. In addition, dobutamine stress echocardiography that was negative for ischemia identified patients at very low risk of perioperative cardiac events. The positive predictive value of ischemia during dobutamine echocardiography was 29%. Dobutamine stress echocardiography may be performed safely in patients with aortic aneurysms. Precipitation of an aneurysmal complication, including rupture, by the test is unlikely. In addition, preoperative dobutamine stress echocardiography can identify patients at very low risk of perioperative cardiac events.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
authors.forename: P A
authors.initials: PA
authors.lastname: Pellikka
authors.forename: V L
authors.initials: VL
authors.lastname: Roger
authors.forename: J K
authors.initials: JK
authors.lastname: Oh
authors.forename: J B
authors.initials: JB
authors.lastname: Seward
authors.forename: A J
authors.initials: AJ
authors.lastname: Tajik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002316:Cardiotonic Agents; D003327:Coronary Disease / Q000000981:diagnostic imaging; D004280:Dobutamine; D005080:Exercise Test / Q000379:methods; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012449:Safety; D014463:Ultrasonography
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine