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Prediction of major cardiac events after peripheral vascular surgery using dipyridamole echocardiography
M D Tischler1, T H Lee, A T Hirsch
1Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
Insights
Dipyridamole echocardiography can predict cardiac events in patients undergoing peripheral vascular surgery. A positive test result significantly increases the risk of postoperative cardiac complications, suggesting its value as a screening tool.
Area of Science:
- Cardiology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Patients undergoing peripheral vascular surgery face elevated risks of postoperative cardiac complications.
- Accurate prediction of cardiac events is crucial for patient management and surgical planning.
Purpose of the Study:
- To assess the efficacy of dipyridamole echocardiography in predicting major cardiac events in patients scheduled for elective peripheral vascular surgery.
- To determine the sensitivity, specificity, and predictive values of dipyridamole echocardiography for postoperative cardiac complications.
Main Methods:
- Prospective study of 109 unselected patients undergoing elective peripheral vascular surgery.
- Preoperative dipyridamole echocardiograms performed and interpreted by blinded echocardiographers.
- Patients followed postoperatively by blinded research physicians; outcomes assessed by independent reviewers.
Main Results:
- Nine patients (8%) had positive dipyridamole echocardiograms, with 7 experiencing postoperative cardiac events (including 3 deaths).
- Only 1 cardiac event occurred among 100 patients with negative echocardiograms.
- Dipyridamole echocardiography demonstrated high sensitivity (88%) and specificity (98%) for predicting cardiac events, with a positive predictive value of 78% and negative predictive value of 99%.
Conclusions:
- Preoperative dipyridamole echocardiography is a highly sensitive and specific predictor of major cardiac events following peripheral vascular surgery.
- The test shows a significantly elevated relative risk (78-fold) of cardiac events when positive.
- Dipyridamole echocardiography may serve as a valuable preoperative screening tool for identifying high-risk patients undergoing elective peripheral vascular surgery.
Abstract:
Patients undergoing peripheral vascular surgery are at increased risk of postoperative cardiac complications. To evaluate the role of dipyridamole echocardiography in predicting major cardiac events, 109 unselected patients undergoing elective peripheral vascular surgery were prospectively studied. Preoperative dipyridamole echocardiograms were interpreted by an echocardiographer unaware of all clinical data. Patients were followed up until hospital discharge by research physicians without knowledge of dipyridamole echocardiography results. Outcomes were classified using strict predefined criteria by reviewers unaware of other clinical and echocardiographic data. Of the 109 patients, 9 (8%) had positive studies defined as development of new regional wall motion abnormalities or worsening of preexistent wall motion abnormalities. Of these 9 patients, 7 had postoperative events, including 3 cardiac deaths, 1 nonfatal myocardial infarction, 2 with unstable angina, and 1 with pulmonary edema. Only 1 event occurred among the 100 patients with negative studies. The sensitivity and specificity of dipyridamole echocardiography for predicting cardiac events after vascular surgery were 88 and 98%, respectively; the positive and negative predictive values were 78 and 99%. The relative risk of having a cardiac event if dipyridamole echocardiography was abnormal was 78 (95% confidence interval, 11 to 564; p less than 0.0001). If these results are extended and confirmed by other investigators, preoperative dipyridamole echocardiography may be an important screening test for patients undergoing elective peripheral vascular surgery.