Dobutamine-atropine stress echocardiography for assessment of perioperative and late cardiac risk in patients undergoing major vascular surgery.

Objective: To determine the value of dobutamine-atropine stress echocardiography and clinical variables to predict perioperative and late cardiac events in patients scheduled for elective major non-cardiac vascular surgery.

Design: Blinded prospective study.

Patients: Patients (n = 187 mean age 69 yrs).

Measurements: Dobutamine-atropine stress test was performed preoperatively. Results were not used for clinical management. The clinical risk profile was evaluated by Detsky's score.

Results: Technically adequate images were obtained in 185/187 patients, one major complication occurred (ventricular fibrillation) and four tests were prematurely stopped due to side effects. Data from 181 patients were analysed. The stress test was positive (new or worsened wall motion abnormality) in 56/181 patients. Perioperative cardiac events were: five fatal myocardial infarctions, three non-fatal myocardial infarctions, nine unstable angina pectoris and one pulmonary edema. All patients with a cardiac event had a positive stress test (18/56). No event occurred in patients with a negative stress test. By multivariate analysis only a new wall motion abnormality during the stress test (odds ratio 45.0, 6-369) was a significant predictor of cardiac events. Patients (n = 154) were followed after operation for 16 +/- 9 months. Twenty-four cardiac events occurred in 21 patients: six fatal myocardial infarctions, three non-fatal myocardial infarctions, six unstable angina pectoris, three ventricular arrhythmias and six congestive heart failures. The stress echo was positive in 19/21 patients with late cardiac events. The cardiac events correlated by multivariate analysis with a history of myocardial infarction (odds ratio 9.6, 1.9-47.7) and new wall motion abnormalities (odds ratio 6.2, 1.5-25.1).

Conclusion: Dobutamine-atropine stress echocardiography is a relatively safe and useful test to identify patients at risk of perioperative and late postoperative cardiac events.