Cardiac events in patients with negative maximal versus negative submaximal dobutamine echocardiograms undergoing noncardiac surgery

Labib, Sherif B.; Goldstein, Michael; Kinnunen, Paula M.; Schick, Edgar C.

doi:10.1016/j.jacc.2004.03.049

Cited by 42 publications

(6 citation statements)

References 34 publications

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“…No MACE occurred in patients without preoperative ischemia, whereas 43% of those with ischemia at low workloads had MACE. In a separate study of 429 participants, dobutamine stress echocardiography had an excellent negative predictive value (98%) for perioperative MACE …”

Section: Methodsmentioning

confidence: 96%

“…Among patients with poor functional capacity (<4 METs) at higher risk for noncardiac surgery, exercise testing with cardiac imaging or noninvasive pharmacological stress testing (either dobutamine stress echocardiography or vasodilator stress myocardial perfusion imaging) to assess for myocardial ischemia is only reasonable if the results from this testing would change perioperative medical management and decisions regarding coronary revascularization . European guidelines recommend stress testing with imaging before high-risk surgery in patients with more than 2 clinical risk factors (using the Revised Cardiac Risk Index) and poor functional capacity (<4 METs) and treatment according to clinical indications independent of surgery .…”

Section: Methodsmentioning

confidence: 99%

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Perioperative Cardiovascular Risk Assessment and Management for Noncardiac Surgery

Smilowitz

Berger

2020

JAMA

176

140

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IMPORTANCEPerioperative cardiovascular complications occur in 3% of hospitalizations for noncardiac surgery in the US. This review summarizes evidence regarding cardiovascular risk assessment prior to noncardiac surgery.OBSERVATIONS Preoperative cardiovascular risk assessment requires a focused history and physical examination to identify signs and symptoms of ischemic heart disease, heart failure, and severe valvular disease. Risk calculators, such as the Revised Cardiac Risk Index, identify individuals with low risk (<1%) and higher risk (Ն1%) for perioperative major adverse cardiovascular events during the surgical hospital admission or within 30 days of surgery. Cardiovascular testing is rarely indicated in patients at low risk for major adverse cardiovascular events. Stress testing may be considered in patients at higher risk (determined by the inability to climb Ն2 flights of stairs, which is <4 metabolic equivalent tasks) if the results from the testing would change the perioperative medical, anesthesia, or surgical approaches. Routine coronary revascularization does not reduce perioperative risk and should not be performed without specific indications independent of planned surgery. Routine perioperative use of low-dose aspirin (100 mg/d) does not decrease cardiovascular events but does increase surgical bleeding. Statins are associated with fewer postoperative cardiovascular complications and lower mortality (1.8% vs 2.3% without statin use; P < .001) in observational studies, and should be considered preoperatively in patients with atherosclerotic cardiovascular disease undergoing vascular surgery. High-dose β-blockers (eg, 100 mg of metoprolol succinate) administered 2 to 4 hours prior to surgery are associated with a higher risk of stroke (1.0% vs 0.5% without β-blocker use; P = .005) and mortality (3.1% vs 2.3% without β-blocker use; P = .03) and should not be routinely used. There is a greater risk of perioperative myocardial infarction and major adverse cardiovascular events in adults aged 75 years or older (9.5% vs 4.8% for younger adults; P < .001) and in patients with coronary stents (8.9% vs 1.5% for those without stents; P < .001) and these patients warrant careful preoperative consideration.CONCLUSIONS AND RELEVANCE Comprehensive history, physical examination, and assessment of functional capacity during daily life should be performed prior to noncardiac surgery to assess cardiovascular risk. Cardiovascular testing is rarely indicated in patients with a low risk of major adverse cardiovascular events, but may be useful in patients with poor functional capacity (<4 metabolic equivalent tasks) undergoing high-risk surgery if test results would change therapy independent of the planned surgery. Perioperative medical therapy should be prescribed based on patient-specific risk.

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Section: Methodsmentioning

confidence: 96%

Section: Methodsmentioning

confidence: 99%

Perioperative Cardiovascular Risk Assessment and Management for Noncardiac Surgery

Smilowitz

Berger

2020

JAMA

176

140

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“…The presence of scar in our study population was shown to have important implications for prediction and freedom from MACE. Utilization of either DSE for wall otion abnormalities or by cardiac magnetic resonance imaging by late gadolinium enhancement for presence of scar, have recognized that presence of scar with or with out ischemia is associated with approximately 4 -11 fold hazards increase risk for MACE and death [3,[19][20][21][22][23][24]. Our study reconfirms this finding, demonstrating presence of scar by DSE carries an increase risk of all cause death and combined MACE for obese African Americans; similarly, presence of scar on DSE in the general population has been associated with adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Utility of Dobutamine Stress Echocardiography in the Obese African American Population

Khan¹,

Valdiviezo²,

Singh³

et al. 2012

OJMI

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Background: The predictive value of Dobutamine Stress Echocardiography (DSE) in the obese African American patient population is not well known. Methods: We conducted a retrospective study of 555 African American patients between 1/1/2001-12/31/2001. DSE responses were classified into normal, ischemia, scar, or scar +/? ischemia. End-points utilized were all cause death (ACD) and major adverse cardiac events (MACE). Results: There were a total of 409 obese patients and 146 non-obese patients. By multi-variate analysis only the scar group in the obese population predicted ACD (p = 0.003) and combined MACE (p = 0.014). Kaplan Meir analysis demonstrated that only the scar group was associated with decrease in freedom from all cause death (p < 0.001) and combined MACE (p < 0.001). Conclusion: DSE retains its prognostic power in the obese African American population and scar has important impli-cations for MACE

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“…Nenhum evento cardiovascular adverso maior (MACE) ocorreu em pacientes sem isquemia pré-operatória, enquanto 43% daqueles com isquemia em baixas cargas de trabalho tiveram MACE. Em um estudo separado com 429 participantes, a ecocardiografia sob estresse com dobutamina teve um valor preditivo negativo relevante (98%) para MACE perioperatório 68 . O teste de estresse de rotina não é indicado para pacientes de baixo risco, que incluem aqueles com excelente capacidade funcional e com capacidade funcional moderada a boa.…”

Section: Avaliação Da Capacidade Funcional E Teste De Estresse Para I...unclassified

“…As diretrizes canadenses não recomendam o teste de esforço préoperatório e o teste de exercício cardiopulmonar, devido a dados limitados que apoiam os testes 64 . Entre os pacientes com baixa capacidade funcional (<4 METs) com maior risco de cirurgia não cardíaca, o teste ergométrico com imagens cardíacas ou teste de estresse farmacológico não invasivoecocardiografia sob estresse com dobutamina ou imagens de perfusão miocárdica sob estresse com vasodilatadorpara avaliar isquemia miocárdica seria apenas considerado se os resultados alterassem o manejo médico perioperatório e as decisões relativas à revascularização coronariana 3,67,68 . As diretrizes europeias, por sua vez, recomendam testes de estresse com exames de imagem antes de cirurgias de alto risco em pacientes com mais de 2 fatores de risco clínicosutilizando o Revised Cardiac Risk Indexe baixa capacidade funcional (<4METs) e tratamento de acordo com indicações clínicas independentes de cirurgia 5 .…”

Section: Avaliação Da Capacidade Funcional E Teste De Estresse Para I...unclassified

Avaliação Dos Riscos Cardíacos Em Procedimentos Cirúrgicos Não Cardíacos: Estratégias Para a Obtenção De Resultados Perioperatórios

Rente,

Resende,

Motta

et al. 2024

Saúde Cardiovascular: Conhecimento, Prevenção E Cuidado

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dependendo das características 3,10 , conforme mostra a Tabela 1. Vários fatores interferem na ocorrência de complicações cardíacas durante ou após cirurgia não cardíaca, sendo divididos principalmente em fatores relacionados ao pacienteestado geral, capacidade funcional e comorbidades cardíacas e fatores relacionados ao procedimento -tipo de cirurgia, pré-operatório, preparação operatória, entre outros 11 . Tabela 1. Riscos cardíacos (baixo, intermediário e alto) associados a diferentes tipos de cirurgias.

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Cardiac events in patients with negative maximal versus negative submaximal dobutamine echocardiograms undergoing noncardiac surgery

Cited by 42 publications

References 34 publications

Perioperative Cardiovascular Risk Assessment and Management for Noncardiac Surgery

Perioperative Cardiovascular Risk Assessment and Management for Noncardiac Surgery

Prognostic Utility of Dobutamine Stress Echocardiography in the Obese African American Population

Avaliação Dos Riscos Cardíacos Em Procedimentos Cirúrgicos Não Cardíacos: Estratégias Para a Obtenção De Resultados Perioperatórios

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