title: Relation between preoperative and intraoperative new wall motion abnormalities in vascular surgery patients: a transesophageal echocardiographic study.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Wael
authors.initials: W
authors.lastname: Galal
authors.forename: Sanne E
authors.initials: SE
authors.lastname: Hoeks
authors.forename: Willem Jan
authors.initials: WJ
authors.lastname: Flu
authors.forename: Jan Peter
authors.initials: JP
authors.lastname: van Kuijk
authors.forename: Dustin
authors.initials: D
authors.lastname: Goei
authors.forename: Tjebbe
authors.initials: T
authors.lastname: Galema
authors.forename: Corstiaan
authors.initials: C
authors.lastname: den Uil
authors.forename: Yvette R B M
authors.initials: YR
authors.lastname: van Gestel
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Hence J M
authors.initials: HJ
authors.lastname: Verhagen
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: 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
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine