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 Scopus citations

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 (US)
Pages (from-to)469-475
Number of pages7
JournalAmerican Heart Journal
Volume137
Issue number3
DOIs
StatePublished - Jan 1 1999

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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