title: Predictive role of stress echocardiography before carotid endarterectomy in patients with coronary artery disease.
abstract: OBJECTIVE
  Our aim was to examine the predictive value of preoperative stress echocardiography regarding early myocardial ischemia and late cardiac events after carotid endarterectomy (CEA).
  
  
  METHODS
  Patients with coronary artery disease undergoing CEA were prospectively included in this study. All patients (n = 162) were classified into low, medium, and high cardiac risk group, according to preoperative stress echocardiography. Classification was based on the criteria of the American Society of Echocardiography. For all patients, cTnI was measured before surgery and on postoperative days 1, 3, and 7. Postoperative cTnI values ranging from 0.05 to 0.5 ng/mL were classified as myocardial ischemia; values >0.5 ng/mL were classified as myocardial infarction. Cardiac damage was defined as either myocardial ischemia or infarction.
  
  
  RESULTS
  No deaths, strokes, or symptomatic coronary events were observed during the early postoperative period. There were 112 low cardiac risk patients, 42 medium-risk patients, and 8 high-risk patients, according to stress echocardiography findings. Overall, there were 22 patients (14%) that increased their cTnI values postoperatively (12 of low cardiac risk and 10 of medium cardiac risk), and all of them were asymptomatic. None of the high-risk patients showed any troponin increase. Late cardiac events were associated with cTnI increase, although no high-risk patients showed any late event.
  
  
  CONCLUSIONS
  Preoperative stress echocardiography does not seem to independently recognize patients in high risk for asymptomatic cardiac damage after CEA. Postoperative troponin elevation seems to be more predictive for late adverse cardiac events than preoperative stress echocardiography.
authors.affiliation: First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Galyfos
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors.forename: Constantinos
authors.initials: C
authors.lastname: Tsioufis
authors.affiliation: First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Theodorou
authors.affiliation: First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors.forename: Stilianos
authors.initials: S
authors.lastname: Katsaragakis
authors.affiliation: First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Zografos
authors.affiliation: First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Filis
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000601:surgery*; D025401:Echocardiography, Stress; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D012307:Risk Factors
keywords: cardiac damage; cardiac risk; cardiac troponin I; carotid endarterectomy; stress echocardiography