Prognosis of patients with vascular disease after clinical evaluation and dobutamine stress echocardiography

Raj S. Ballal, Samir Kapadia, Maria Anna Secknus, David Rubin, Kristopher Arheart, Thomas H. Marwick

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Coronary disease is an important cause of long-term morbidity in patients needing major vascular surgery. We sought to assess the efficacy of preoperative clinical evaluation and the detection of inducible ischemia for prediction of immediate and long-term cardiac outcomes of patients undergoing vascular surgery. Methods: In 233 patients undergoing vascular procedures, we assessed risk clinically on the basis of Eagle's criteria. Dobutamine echocardiography was performed with a standard protocol and results were classified as showing ischemia, scar, or a normal response. Patients were observed perioperatively, and late follow-up (28 ± 13 months) was completed in all surgical survivors. A composite end point of cardiac death, myocardial infarction, and unstable and progressive angina requiring late revascularization was used to judge event-free survival. Results: Of 233 patients undergoing preoperative dobutamine echocardiography, 39 (17%) had inducible ischemia and 36 (15%) had scar. Perioperative events occurred in 8 patients (3%). None of the patients with ischemia had perioperative events, reflecting the effect of revascularization in 9 patients. Late events occurred in 36 patients; ischemia on preoperative stress testing was a predictor of these events even after adjusting for clinical variables and left ventricular dysfunction (relative risk = 3.3; 95% confidence interval 1.6 to 6.8; P = .001). The association of ischemia with clinical predictors was associated with incrementally worse outcome. Conclusion: In addition to perioperative assessment, the combined use of clinical and dobutamine echocardiographic evaluation may stratify the risk of late cardiac events.

Original languageEnglish
Pages (from-to)469-475
Number of pages7
JournalAmerican Heart Journal
Volume137
Issue number3
StatePublished - Mar 22 1999
Externally publishedYes

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Stress Echocardiography
Vascular Diseases
Ischemia
Dobutamine
Blood Vessels
Cicatrix
Echocardiography
Eagles
Unstable Angina
Left Ventricular Dysfunction
Disease-Free Survival
Coronary Disease
Survivors
Myocardial Infarction
Confidence Intervals
Morbidity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ballal, R. S., Kapadia, S., Secknus, M. A., Rubin, D., Arheart, K., & Marwick, T. H. (1999). Prognosis of patients with vascular disease after clinical evaluation and dobutamine stress echocardiography. American Heart Journal, 137(3), 469-475.

Prognosis of patients with vascular disease after clinical evaluation and dobutamine stress echocardiography. / Ballal, Raj S.; Kapadia, Samir; Secknus, Maria Anna; Rubin, David; Arheart, Kristopher; Marwick, Thomas H.

In: American Heart Journal, Vol. 137, No. 3, 22.03.1999, p. 469-475.

Research output: Contribution to journalArticle

Ballal, RS, Kapadia, S, Secknus, MA, Rubin, D, Arheart, K & Marwick, TH 1999, 'Prognosis of patients with vascular disease after clinical evaluation and dobutamine stress echocardiography', American Heart Journal, vol. 137, no. 3, pp. 469-475.
Ballal RS, Kapadia S, Secknus MA, Rubin D, Arheart K, Marwick TH. Prognosis of patients with vascular disease after clinical evaluation and dobutamine stress echocardiography. American Heart Journal. 1999 Mar 22;137(3):469-475.
Ballal, Raj S. ; Kapadia, Samir ; Secknus, Maria Anna ; Rubin, David ; Arheart, Kristopher ; Marwick, Thomas H. / Prognosis of patients with vascular disease after clinical evaluation and dobutamine stress echocardiography. In: American Heart Journal. 1999 ; Vol. 137, No. 3. pp. 469-475.
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