Applicability and interpretation of electrocardiographic stress testing in patients with peripheral vascular disease

Cutler, Bruce S.; Wheeler, H. Brownell; Paraskos, John A; Cardullo, Paul A.

doi:10.1016/0002-9610(81)90148-3

Cited by 128 publications

(15 citation statements)

References 11 publications

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“…These have included multifactorial clinical scoring systems 2-4 based on non-invasive tests such as ambulatory electrocardiography, 5-12 exercise electrocardiography, [13][14][15][16][17][18][19] radionuclide ventriculography, [20][21][22][23][24][25][26][27] and myocardial perfusion scintigraphy. 10 28-49 It has been suggested that the most accurate information about the individual patient risk profile can be obtained by adding clinical characteristics to those obtained by myocardial perfusion scintigraphy.…”

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confidence: 99%

A meta-analysis comparing the prognostic accuracy of six diagnostic tests for predicting perioperative cardiac risk in patients undergoing major vascular surgery

Kertai

Boersma

Bax

et al. 2003

Heart

246

119

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Objective: To evaluate the discriminatory value and compare the predictive performance of six noninvasive tests used for perioperative cardiac risk stratification in patients undergoing major vascular surgery. Design: Meta-analysis of published reports. Methods: Eight studies on ambulatory electrocardiography, seven on exercise electrocardiography, eight on radionuclide ventriculography, 23 on myocardial perfusion scintigraphy, eight on dobutamine stress echocardiography, and four on dipyridamole stress echocardiography were selected, using a systematic review of published reports on preoperative non-invasive tests from the Medline database (January 1975 and April 2001). Random effects models were used to calculate weighted sensitivity and specificity from the published results. Summary receiver operating characteristic (SROC) curve analysis was used to evaluate and compare the prognostic accuracy of each test. The relative diagnostic odds ratio was used to study the differences in diagnostic performance of the tests. Results: In all, 8119 patients participated in the studies selected. Dobutamine stress echocardiography had the highest weighted sensitivity of 85% (95% confidence interval (CI) 74% to 97%) and a reasonable specificity of 70% (95% CI 62% to 79%) for predicting perioperative cardiac death and non-fatal myocardial infarction. On SROC analysis, there was a trend for dobutamine stress echocardiography to perform better than the other tests, but this only reached significance against myocardial perfusion scintigraphy (relative diagnostic odds ratio 5.5, 95% CI 2.0 to 14.9). Conclusions: On meta-analysis of six non-invasive tests, dobutamine stress echocardiography showed a positive trend towards better diagnostic performance than the other tests, but this was only significant in the comparison with myocardial perfusion scintigraphy. However, dobutamine stress echocardiography may be the favoured test in situations where there is valvar or left ventricular dysfunction. P atients undergoing major vascular surgery are at increased risk for cardiovascular complications such as cardiac death and non-fatal myocardial infarction because of underlying coronary artery disease.

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confidence: 99%

A meta-analysis comparing the prognostic accuracy of six diagnostic tests for predicting perioperative cardiac risk in patients undergoing major vascular surgery

Kertai

Boersma

Bax

et al. 2003

Heart

246

119

View full text Add to dashboard Cite

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“…3 In the decade that followed, multivariable analyses identified combinations of factors (risk indexes), generally based on routine clinical and laboratory tests, 4-7 that could be used to estimate the risk of cardiac complications. Most recently, some investigators have argued that routine clinical evaluation before surgery is neither sufficiently sensitive nor specific enough for risk assessment and have recommended specialized testing, including exercise stress testing and ambulatory electrocardiography [8][9][10] and echocardiography, [11][12][13] radionuclide ventriculography, 14 and dipyridamole-thallium scintigraphy. 15,16 The implications of these recommendations are substantial, for the tests are not only costly but also may increase the likelihood that other costly tests and treatments will be used.…”

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confidence: 99%

Preoperative Assessment of Patients with Known or Suspected Coronary Disease

1995

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“…Risk stratification with exercise electrocardiography has been performed [8-16], but this type of testing is not suitable for patients with peripheral vascular disease due to their inability to reach an ischemic threshold. Cutler et al [9] demonstrated that patient who achieved >75% of maximum predicted heart rate and no ischemic electrocardiographic modifications did not develop postoperative cardiac complications, whereas there were 10 postoperative cardiac events, including 7 myocardial infarctions (25%), in the high risk group.…”

Section: Risk Stratification: Which Test Is Best?mentioning

confidence: 99%

Perioperative risk stratification in non cardiac surgery: role of pharmacological stress echocardiography

Sicari

2004

Cardiovasc Ultrasound

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Perioperative ischemia is a frequent event in patients undergoing major non-cardiac vascular or general surgery. This is in agreement with clinical, pathophysiological, and epidemiological evidence and constitutes an additional diagnostic therapeutic factor in the assessment of these patients. Form a clinical standpoint, it is well known that multidistrict disease, especially at the coronary level, is a severe aggravation of the operative risk. From a pathophysiological point of view, however, surgery creates conditions able to unmask coronary artery disease. Prolonged hypotension, hemorrhages, and haemodynamic stresses caused by aortic clamping and unclamping during major vascular surgery are the most relevant factors endangering the coronary circulation with critical stenoses. From the epidemiological standpoint, coronary disease is known to be the leading cause of perioperative mortality and morbidity following vascular and general surgery: The diagnostic therapeutic corollary of these considerations is that coronary artery disease -and therefore the perioperative risk -in these patients has to be identified in an effective way preoperatively.

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Applicability and interpretation of electrocardiographic stress testing in patients with peripheral vascular disease

Cited by 128 publications

References 11 publications

A meta-analysis comparing the prognostic accuracy of six diagnostic tests for predicting perioperative cardiac risk in patients undergoing major vascular surgery

A meta-analysis comparing the prognostic accuracy of six diagnostic tests for predicting perioperative cardiac risk in patients undergoing major vascular surgery

Preoperative Assessment of Patients with Known or Suspected Coronary Disease

Perioperative risk stratification in non cardiac surgery: role of pharmacological stress echocardiography

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