Assessment of cardiac risk before aortic reconstruction: noninvasive work-up using clinical examination, exercise testing, and dobutamine stress echocardiography versus routine coronary arteriography.
In this prospective study we evaluated the efficacy of a battery of noninvasive tests including clinical evaluation (CE), exercise testing (ET), and dobutamine stress echocardiography (DSE) for assessment of cardiac risk in 90 patients indicated for aortic reconstruction. As the gold-standard reference technique, coronary arteriography was performed in each patient after noninvasive evaluation. The sensitivity of CE was low (61%). ET proved to be more sensitive (71.4%) and highly specific (95.8%) but feasibility (77%) and diagnostic accuracy (42%) were low. DSE demonstrated acceptable sensitivity (78%) and specificity (75.5%) with high feasibility (94.5%) and diagnostic accuracy (100%). None of the four patients with false negative ET results and only one of seven with false-negative DSE required coronary bypass. On the basis of these findings we conclude that a combination of CE and ET with DES, if necessary, can reliably assess cardiac risk before aortic reconstruction. Noninvasive assessment is a reliable alternative to routine coronary arteriography.
Therre
T
T
Service de Chirurgie Vasculaire and Service de Cardiologie, Hôpital G. Montpied, Clermont-Ferrand, France.
Ribal
J P
JP
Motreff
P
P
Lusson
J R
JR
Espeut
J B
JB
Cassagnes
J
J
Glanddier
G
G
D000318:Adrenergic beta-Agonists; D000328:Adult; D000368:Aged; D001018:Aortic Diseases / Q000601:surgery*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000175:diagnosis*; D003402:Creatine Kinase / Q000097:blood; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography; D005080:Exercise Test; D005188:False Negative Reactions; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D007527:Isoenzymes; D008875:Middle Aged; D010808:Physical Examination; D011300:Preoperative Care; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity
D000318:Adrenergic beta-Agonists; D007527:Isoenzymes; D004280:Dobutamine; D003402:Creatine Kinase