Dobutamine stress echocardiography as a predictor of cardiac events associated with aortic surgery

Stephen G. Lalka, Stephen Sawada, Michael Dalsing, Dolores F. Cikrit, Alan Sawchuk, Roxanne L. Kovacs, Douglas S. Segar, Thomas Ryan, Harvey Feigenbaum

Research output: Contribution to journalArticle

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Abstract

Two-dimensional echocardiography can detect regional wall motion abnormalities resulting from myocardial ischemia produced by dobutamine infusion. In 60 patients undergoing elective aortic surgery (27 with aneurysms, 33 with occlusive disease), we evaluated the ability of dobutamine stress echocardiography to predict perioperative cardiac events. Echo images were obtained at rest and during incremental dobutamine infusion to a peak dose of 50 μg/kg/min, unless another test end point was reached (angina, heart rate ≥85% of age-predicted maximum, significant ST segment depression, or new stress-induced wall motion abnormalities). Dobutamine stress echocardiography results were stratified as follows: group I, no wall motion abnormalities; group II, resting wall motion abnormalities unchanged with stress; group III, stress-induced worsening of resting wall motion abnormalites; group IV, new-onset wall motion abnormalities with stress. Twelve cardiac events occurred within the first 30 postoperative days: three cardiac deaths (5%), six nonfatal myocardial infarctions (10%), two patients with unstable angina (3.3%), and one patient with asymptomatic elevation of creatine phosphokinase MB isoenzymes without electrocardiographic changes (1.7%). Eleven events occurred in the 38 patients with an abnormal dobutamine stress echocardiograph (groups II to IV); in contrast, only one of 22 patients with a normal dobutamine stress echocardiograph (group I) had a cardiac event. These event rates (29% vs 4.6%) differed significantly (p < 0.025). Dobutamine stress echocardiography is a new, safe, rapid, relatively low cost, noninvasive, nonexercise cardiac stress test for risk stratification before major vascular surgery.

Original languageEnglish
Pages (from-to)831-842
Number of pages12
JournalJournal of Vascular Surgery
Volume15
Issue number5
DOIs
StatePublished - 1992

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Stress Echocardiography
Dobutamine
Unstable Angina
Creatine Kinase
Exercise Test
Isoenzymes
Myocardial Ischemia
Aneurysm
Blood Vessels
Echocardiography
Heart Rate
Myocardial Infarction
Costs and Cost Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Dobutamine stress echocardiography as a predictor of cardiac events associated with aortic surgery. / Lalka, Stephen G.; Sawada, Stephen; Dalsing, Michael; Cikrit, Dolores F.; Sawchuk, Alan; Kovacs, Roxanne L.; Segar, Douglas S.; Ryan, Thomas; Feigenbaum, Harvey.

In: Journal of Vascular Surgery, Vol. 15, No. 5, 1992, p. 831-842.

Research output: Contribution to journalArticle

Lalka, Stephen G. ; Sawada, Stephen ; Dalsing, Michael ; Cikrit, Dolores F. ; Sawchuk, Alan ; Kovacs, Roxanne L. ; Segar, Douglas S. ; Ryan, Thomas ; Feigenbaum, Harvey. / Dobutamine stress echocardiography as a predictor of cardiac events associated with aortic surgery. In: Journal of Vascular Surgery. 1992 ; Vol. 15, No. 5. pp. 831-842.
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