Cardiac events in patients with negative maximal versus negative submaximal dobutamine echocardiograms undergoing noncardiac surgery: importance of resting wall motion abnormalities

Journal of the American College of Cardiology
Sherif B LabibEdgar C Schick

Abstract

This study sought to evaluate the negative predictive value (NPV) of preoperative dobutamine stress echocardiography (DSE) in patients who fail to achieve target heart rate (HR) and assess the influence of resting wall motion abnormalities (WMAs) without demonstrable ischemia on perioperative events. The prognostic value of a negative-submaximal DSE study before noncardiac surgery is unknown. Consecutive patients (n = 429) who underwent surgery over a three-year period, preceded by DSE, were included. We compared perioperative event rates among those without inducible ischemia according to whether or not 85% age-adjusted maximum HR was achieved, and whether WMAs were present at rest. Of 397 negative DSEs, peak HR was <85% maximum predicted in 62 (16%). Most were receiving beta-blockers (77%). The average dobutamine and atropine doses were 48 microg/kg/min and 1.2 mg, respectively. Average HR was 115 beats/min (74% maximum predicted). Perioperative myocardial infarctions occurred more frequently in patients with positive tests (3 of 32 [9.4%] vs. 7 of 397 [1.8%]; p = 0.03), but with similar frequency among the negative-maximal and negative-submaximal groups (6 of 335, 1.8% vs. 1 of 62, 1.6%, respectively). Accordingly, the NPV w...Continue Reading

References

Jan 1, 1992·Journal of the American College of Cardiology·T H MarwickE E Salcedo
Aug 1, 1973·Archives of Surgery·R D SautterF J Wenzel
Aug 1, 1995·Circulation·E FalkV Fuster
Sep 1, 1995·Journal of the American College of Cardiology·D PoldermansH van Urk
Sep 1, 1993·The American Journal of Cardiology·J P EichelbergerK Ouriel
Mar 15, 1993·Journal of the American College of Cardiology·V G Dávila-RománJ E Pérez
Dec 1, 1996·Circulation·R O Bonow
May 1, 1997·Journal of the American College of Cardiology·M A Secknus, T H Marwick
Sep 2, 1999·The Journal of Thoracic and Cardiovascular Surgery·E BossoneD S Bach
Mar 18, 2000·Cardiovascular Pathology : the Official Journal of the Society for Cardiovascular Pathology·M C Cohen, T H Aretz
May 12, 2000·Journal of the American College of Cardiology·M K DasJ B Seward
Nov 6, 2001·Journal of the American College of Cardiology·T H MarwickM Lauer
Mar 15, 2002·The New England Journal of Medicine·Jonathan MyersJ Edwin Atwood

❮ Previous
Next ❯

Citations

Mar 25, 2009·Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology·Bradley A BartCharles A Herzog
Jun 27, 2006·Circulation Journal : Official Journal of the Japanese Circulation Society·Ryotaro WakeJunichi Yoshikawa
Jun 27, 2008·European Journal of Echocardiography : the Journal of the Working Group on Echocardiography of the European Society of Cardiology·Rosa SicariUNKNOWN European Association of Echocardiography
Jul 22, 2020·JAMA : the Journal of the American Medical Association·Nathaniel R Smilowitz, Jeffrey S Berger
May 4, 2010·The Journal of the American Academy of Orthopaedic Surgeons·Robert C DeckerThomas J Moore

❮ Previous
Next ❯

Related Concepts

Related Feeds

Antianginal Drugs: Mechanisms of Action

Antianginal drugs, including nitrates, beta-blockers, and calcium channel blockers, are used in the treatment of angina pectoris. Here is the latest research on their use and their mechanism of action.

Cardiology Journals

Discover the latest cardiology research in this collection of the top cardiology journals.