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Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
Relation between preoperative and intraoperative new wall motion abnormalities in vascular surgery patients: a
Wael Galal1, Sanne E Hoeks, Willem Jan Flu
1Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Insights
Preoperative stress tests for coronary artery disease in vascular surgery patients do not predict intraoperative new wall motion abnormalities. Intraoperative findings, however, correlate with adverse cardiac events.
Area of Science:
- Cardiology
- Vascular Surgery
- Echocardiography
Background:
- Coronary revascularization guided by preoperative stress testing lacks proven outcome benefits in vascular surgery patients.
- Assessing cardiac risk in major vascular surgery is crucial due to high perioperative morbidity and mortality.
Purpose of the Study:
- To compare preoperative dobutamine echocardiography (DE) with intraoperative transesophageal echocardiography (TEE) in identifying new wall motion abnormalities (NWMAs) in vascular surgery patients.
- To determine the correlation between stress-induced NWMAs and perioperative cardiac outcomes.
Main Methods:
- Fifty-four major vascular surgery patients underwent DE and intraoperative TEE.
- Left ventricular wall motion abnormalities were assessed using a seven-wall model.
- Cardiac outcomes, including troponin release, myocardial infarction, and cardiac death, were monitored for 30 days.
Main Results:
- Agreement for rest wall motion abnormalities between DE and TEE was excellent (kappa = 0.92).
- Agreement for new wall motion abnormalities (NWMAs) between DE and TEE was poor (kappa = 0.26-0.44).
- The composite cardiac endpoint occurred in 26% of patients, with a higher frequency related to intraoperative NWMAs.
Conclusions:
- There is a poor correlation between preoperatively and intraoperatively identified stress-induced NWMAs.
- Intraoperative NWMAs, identified by TEE, were more frequently associated with adverse cardiac outcomes than preoperative findings.
Background:
Coronary revascularization of the suspected culprit coronary lesion assessed by preoperative stress testing is not associated with improved outcome in vascular surgery patients.
Methods:
Fifty-four major vascular surgery patients underwent preoperative dobutamine echocardiography and intraoperative transesophageal echocardiography. The locations of left ventricular rest wall motion abnormalities and new wall motion abnormalities (NWMAs) were scored using a seven-wall model. During 30-day follow-up, postoperative cardiac troponin release, myocardial infarction, and cardiac death were noted.
Results:
Rest wall motion abnormalities were noted by dobutamine echocardiography in 17 patients (31%), and transesophageal echocardiography was noted in 16 (30%). NWMAs were induced during dobutamine echocardiography in 17 patients (31%), whereas NWMAs were observed by transesophageal echocardiography in 23 (43%), kappa value = 0.65. Although preoperative and intraoperative rest wall motion abnormalities showed an excellent agreement for the location (kappa value = 0.92), the agreement for preoperative and intraoperative NWMAs in different locations was poor (kappa value = 0.26-0.44). The composite cardiac endpoint occurred in 14 patients (26%).
Conclusions:
There was a poor correlation between the locations of preoperatively assessed stress-induced NWMAs by dobutamine echocardiography and those observed intraoperatively using transesophageal echocardiography. However, the composite endpoint of outcome was met more frequently in relation with intraoperative NWMAs.
