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[Evaluation of cardiac risk before vascular surgery by dobutamine stress echocardiography]
P Motreff1, E Pierre-Justin, C Dauphin
1Service de cardiologie et maladies vasculaires, hôpital Gabriel-Montpied, Clermont-Ferrand.
Insights
Dobutamine stress echocardiography effectively screens for coronary artery disease before abdominal aortic surgery. This non-invasive method reliably identifies patients needing further cardiac evaluation, improving surgical safety.
Area of Science:
- Cardiology
- Vascular Surgery
- Diagnostic Imaging
Context:
- Preoperative risk stratification is crucial for patients undergoing abdominal aortic surgery.
- Standard diagnostic methods for coronary artery disease have limitations.
- Coronary artery disease detection is essential before major vascular procedures.
Purpose:
- To evaluate the efficacy of dobutamine stress echocardiography (DSE) in detecting coronary artery disease in patients scheduled for abdominal aortic surgery.
- To compare DSE findings with coronary angiography results.
- To assess the impact of DSE on surgical decision-making and patient outcomes.
Summary:
- Eighty-five patients with abdominal aortic aneurysms or obstructive arterial disease underwent DSE followed by coronary angiography.
- DSE demonstrated a sensitivity of 78% and specificity of 75% for detecting significant coronary lesions (>=50% stenosis).
- Positive DSE results correlated with a higher risk of cardiac complications and guided decisions for myocardial revascularization or surgical postponement.
Impact:
- Dobutamine stress echocardiography is a reliable, non-invasive, and economical alternative to isotopic methods for preoperative coronary assessment.
- The study confirms the necessity of preoperative coronary risk assessment and the effectiveness of DSE in this context.
- Positive DSE results accurately predict significant coronary artery disease, justifying selective coronary angiography.
Abstract:
The detection of coronary artery disease is essential before abdominal aortic surgery. In view of the limitations of the usual methods of investigation, dobutamine stress echocardiography was assessed in this indication. Eighty-five patients with an aortic abdominal aneurysm or obstructive arterial disease underwent dobutamine stress echocardiography followed by coronary angiography. Depending on the results, vascular surgery was performed directly, after myocardial revascularisation or not at all. Significant coronary lesions (stenosis > or = 50%) were found in 32 of the 85 patients (38%). Dobutamine stress echocardiography had a sensitivity of 78% and a specificity of 75%, and positive and negative predictive values of 66 and 85% respectively. The relative risk of coronary disease was 4.4. In this series, 15 patients had severe coronary lesions: 2 were turned down for surgery and 13 underwent myocardial revascularisation; 14 of them (93%) had a positive stress echo. The only 2 non-fatal cardiac complications of peripheral surgery (3%) occurred after a positive dobutamine stress echo. This study confirms both the necessity of preoperative assessment of coronary risk and the efficacy of dobutamine stress echocardiography in this indication. Dobutamine stress echocardiography is reliable, non-invasive, economical and a real alternative to isotopic methods. Its good predictive value justifies using coronary angiography only for patients with a positive result.