title: Dobutamine stress echocardiography for the preoperative evaluation of patients undergoing lung volume reduction surgery.
abstract: BACKGROUND
  Lung volume reduction surgery has been proposed as a bridge to lung transplantation and as definitive therapy for advanced chronic obstructive lung disease. However, patient selection criteria and optimal preoperative assessment have not been clearly defined.
  
  
  OBJECTIVE
  We investigated the feasibility, safety, and value of dobutamine stress echocardiography as a predictor of major early cardiac events in patients who underwent lung volume reduction surgery.
  
  
  METHODS
  The study population consisted of 46 patients (21 men and 25 women, mean age 59 +/- 9 years) who underwent dobutamine stress echocardiography (maximum dose 40 microg. kg(-1). min(-1) plus atropine if needed) 180 days or less before lung volume reduction surgery. Adverse cardiac events were prospectively defined and tabulated during hospitalization after the operation and at subsequent outpatient visits.
  
  
  RESULTS
  Dobutamine stress echocardiography was interpretable in 45 of 46 (98%) patients. There were no adverse events during testing. The studies revealed normal left ventricular systolic function at rest in all patients and normal right ventricular function in all patients but one. Thirteen patients had right ventricular enlargement. Estimated right ventricular systolic pressure was mildly elevated (>40 mm Hg) in 5 patients. Four patients (9%) had stress tests positive for ischemia. There were no perioperative deaths. Follow-up was available for 44 of 45 patients at a duration of 20.0 +/- 7.0 months. Two major adverse cardiac events occurred in the same patient in whom the results of dobutamine stress echocardiography were positive for ischemia (positive predictive value 25%, 95% confidence interval 0% to 83%; negative predictive value 100%, 95% confidence interval 90 to 100%).
  
  
  CONCLUSIONS
  Despite end-stage chronic obstructive lung disease and poor ultrasound windows, dobutamine stress echocardiography is feasible and safe in patients undergoing evaluation for lung volume reduction surgery. It yields important information on right and left ventricular function and has an excellent negative predictive value for early and late adverse cardiac events.
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor 48109-0273, USA.
authors.forename: E
authors.initials: E
authors.lastname: Bossone
authors.forename: F J
authors.initials: FJ
authors.lastname: Martinez
authors.forename: R I
authors.initials: RI
authors.lastname: Whyte
authors.forename: M D
authors.initials: MD
authors.lastname: Iannettoni
authors.forename: W F
authors.initials: WF
authors.lastname: Armstrong
authors.forename: D S
authors.initials: DS
authors.lastname: Bach
mesh_terms: D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D004280:Dobutamine; D015150:Echocardiography, Doppler / Q000379:methods; D005080:Exercise Test; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008173:Lung Diseases, Obstructive / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012449:Safety; D016276:Ventricular Function
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine