Dobutamine stress echocardiography. Stressing the indications for preoperative testing

Poldermans et al have added important data to the body of literature supporting the use of dobutamine stress echocardiography to define long-term cardiac risk for patients undergoing major vascular surgery. In the application of this or any other noninvasive study, it will remain important to select the appropriate population for testing. In the case of noninvasive testing before vascular surgery, the population should consist of patients at intermediate risk of an adverse cardiac event rather than the whole population with known or suspected coronary artery disease. If this is done, testing can be restricted to a group for whom results will affect clinical decision making. Clinical assessment should remain the first method of patient screening. Among patients identified by clinical markers as at intermediate risk for a perioperative or late cardiac event, noninvasive testing such as dobutamine stress echocardiography may be used to better stratify risk and to help guide perioperative and subsequent cardiac management.