Improved stratification of perioperative cardiac risk in patients undergoing noncardiac surgery using new indices of dobutamine stress echocardiography.
OBJECTIVE
Prediction of perioperative cardiac events associated with noncardiac surgery remains difficult in patients whose functional capacity cannot be evaluated by exercise testing. Dobutamine stress echocardiography (DSE) has been used in these patients to improve risk stratification, but the results of standard DSE provide only a binary index of risk (positive or negative). Two new semiquantitative indices of DSE (semi-DSE) were retrospectively examined to determine the prediction of perioperative cardiac events compared to standard DSE.


RESULTS
Clinical assessment of cardiac risk factors and standard DSE were performed safely in 122 consecutive patients (73 men, 49 women) undergoing noncardiac surgery. Preoperative revascularization was performed in 12 patients. The perioperative cardiac events consisted of 2 deaths, 4 cases of heart failure, and 2 cases of angina pectoris. For the semi-DSE indices, the extent of ischemia was indexed as the number of wall segments (SEG) displaying biphasic or worsening segmental wall-motion score, and the severity of ischemia (SI) was indexed as the sum of the differences in wall-motion scores between peak stress and rest divided by the number of affected segments. The optimal cut-off values of these indices for predicting cardiac events were 4.0 for SEG and 1.0 for SI. The risk stratification was further refined by these indices (high-, moderate-, and low-risk groups). The diagnostic accuracy of the semi-DSE indices, evaluated by the area under the receiver operating characteristic curves, was better than that of standard DSE (p < 0.001).


CONCLUSIONS
Semi-DSE may improve cardiac-event risk stratification compared to standard DSE in patients undergoing noncardiac surgery whose functional capacity cannot be evaluated by exercise stress testing.
Yokoshima
Tomoko
T
The First Department of Internal Medicine, Nippon Medical School, Tokyo.
Honma
Hiroshi
H
Kusama
Yoshiki
Y
Munakata
Kazuo
K
Takano
Teruo
T
Nakanishi
Kazuhiro
K
D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D004280:Dobutamine; D025401:Echocardiography, Stress; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000601:surgery; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
D004280:Dobutamine