Relation between preoperative and intraoperative new wall motion abnormalities in vascular surgery patients: a transesophageal echocardiographic study.
BACKGROUND
Coronary revascularization of the suspected culprit coronary lesion assessed by preoperative stress testing is not associated with improved outcome in vascular surgery patients.


METHODS
Fifty-four major vascular surgery patients underwent preoperative dobutamine echocardiography and intraoperative transesophageal echocardiography. The locations of left ventricular rest wall motion abnormalities and new wall motion abnormalities (NWMAs) were scored using a seven-wall model. During 30-day follow-up, postoperative cardiac troponin release, myocardial infarction, and cardiac death were noted.


RESULTS
Rest wall motion abnormalities were noted by dobutamine echocardiography in 17 patients (31%), and transesophageal echocardiography was noted in 16 (30%). NWMAs were induced during dobutamine echocardiography in 17 patients (31%), whereas NWMAs were observed by transesophageal echocardiography in 23 (43%), kappa value = 0.65. Although preoperative and intraoperative rest wall motion abnormalities showed an excellent agreement for the location (kappa value = 0.92), the agreement for preoperative and intraoperative NWMAs in different locations was poor (kappa value = 0.26-0.44). The composite cardiac endpoint occurred in 14 patients (26%).


CONCLUSIONS
There was a poor correlation between the locations of preoperatively assessed stress-induced NWMAs by dobutamine echocardiography and those observed intraoperatively using transesophageal echocardiography. However, the composite endpoint of outcome was met more frequently in relation with intraoperative NWMAs.
Galal
Wael
W
Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Hoeks
Sanne E
SE
Flu
Willem Jan
WJ
van Kuijk
Jan Peter
JP
Goei
Dustin
D
Galema
Tjebbe
T
den Uil
Corstiaan
C
van Gestel
Yvette R B M
YR
Bax
Jeroen J
JJ
Verhagen
Hence J M
HJ
Poldermans
Don
D
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging*; D002316:Cardiotonic Agents; D015331:Cohort Studies; D004280:Dobutamine; D017548:Echocardiography, Transesophageal; D023381:Endpoint Determination; D006321:Heart / Q000502:physiology*; D006801:Humans; D007432:Intraoperative Period; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011446:Prospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D016277:Ventricular Function, Left / Q000502:physiology
D002316:Cardiotonic Agents; D004280:Dobutamine