Prognostic value of dobutamine-atropine stress echocardiography for peri-operative and late cardiac events in patients scheduled for vascular surgery.
Cardiac events in the peri-operative phase and late after non-cardiac vascular surgery are a major cause of morbidity and mortality. Numerous tests and diagnostic strategies--usually consisting of a combination of analysis of clinical risk factors and additional non-exercise dependent stress testing, such as thallium scintigraphy, or stress echocardiography--have been developed to preoperatively identify patients with increased risk. The tests ideally should identify three subpopulations in a group with a high prevalence of coronary artery disease; (1) low-risk patients who can be referred for surgery without extra cardiac intervention. (2) patients whose peri-operative cardiac risk outweighs the potential benefits of vascular surgery, (3) patients whose risk may be reduced by peri-operative therapeutic interventions. This review will discuss the prognostic value of dobutamine stress echocardiography for risk stratification in patients scheduled for non-cardiac vascular surgery and discuss guidelines for future management.
Poldermans
D
D
Department of Surgery, University Hospital Rotterdam-Dijkzigt, The Netherlands.
Rambaldi
R
R
Fioretti
P M
PM
Boersma
E
E
Thomson
I R
IR
van Sambeek
M R
MR
van Urk
H
H
D001285:Atropine; D002316:Cardiotonic Agents; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test / Q000379:methods; D006801:Humans; D010276:Parasympatholytics; D011183:Postoperative Complications / Q000175:diagnosis*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality
D002316:Cardiotonic Agents; D010276:Parasympatholytics; D004280:Dobutamine; D001285:Atropine