Long-term prognostic value of dipyridamole echocardiography in vascular surgery: a large-scale multicenter study.
BACKGROUND
Late cardiac events after non-cardiac major vascular surgery are an important cause of morbidity and mortality. The aim of the present study was to assess the value of a preoperative dipyridamole echocardiography test (up to 0.84 mg/kg over 10 min) in predicting late cardiac events in survivors of major non-cardiac vascular surgery.


METHODS
Large-scale, multicenter, prospective, observational study design.


METHODS
Two hundred and seventy-six patients (mean age 66 +/- 9 years) were studied prior to vascular surgery by dipyridamole stress echocardiography in four different centres. All patients underwent preoperative clinical risk assessment according to the American Heart Association guidelines. All underwent dipyridamole stress echocardiography according to standard high-dose protocol.


RESULTS
No major complications occurred during dipyridamole stress echocardiography. Sixty-three patients (23%) had a positive test. Patients were followed up for a median of 20 months. Cardiac events occurred in 43 patients (16%): five deaths, 18 myocardial infarctions and 20 cases of unstable angina. The difference between wall-motion score index (WMSI) at rest and peak stress (delta WMSI), using multivariate analysis, was an independent predictor of late cardiac death.


CONCLUSIONS
Dipyridamole stress echocardiography performed before major vascular surgery identifies patients at high risk for late cardiac events. Stress echocardiographic parameters outperformed clinical variables in the long-term risk stratification in this set of patients.
Sicari
Rosa
R
Institute of Clinical Physiology, Via G. Moruzzi, Pisa. rosas@ifc.cnr.it
Ripoli
Andrea
A
Picano
Eugenio
E
Pulignano
Giovanni
G
Minardi
Giovanni
G
Rossi
Elisabetta
E
Matskeplishvili
Simon
S
D000368:Aged; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology; D004176:Dipyridamole; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality*; D014665:Vasodilator Agents
D014665:Vasodilator Agents; D004176:Dipyridamole