Predictive value of dobutamine echocardiography just before noncardiac vascular surgery

ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

“…Only 2 studies blinded the physicians and surgeons who treated the patients to the dobutamine stress echocardiography results. 160,241 In the remaining studies, the results were used to influence preoperative management, particularly the decision whether or not to proceed with coronary angiography or coronary revascularization before elective surgery. Each study used similar but not identical protocols.…”

2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

“…89 Patients with MR had worse primary outcomes (defined as composite of 30-day death and postoperative MI, HF, and stroke) than did patients without MR (22.2% versus 16.4%; P<0.02). Important predictors of postoperative adverse outcomes after noncardiac surgery were EF <35%, ischemic cause of MR, history of diabetes mellitus, and history of carotid endarterectomy.…”

“…86 Left-sided regurgitant lesions convey increased cardiac risk during noncardiac surgery but are better tolerated than stenotic valvular disease. 88,89 AR and MR are associated with LV volume overload. To optimize forward cardiac output during anesthesia and surgery, 1) preload should be maintained because the LV has increased size and compliance, and 2) excessive systemic afterload should be avoided so as to augment cardiac output and reduce the regurgitation volume.…”

2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

“…[231][232][233][234][235][236] The use of DSE in preoperative risk assessment was evaluated in 16 studies, all published since 1991 and identified by a computerized search of the English language literature (Table 8). 146,149,160,[237][238][239][240][241][242][243][244][245][246][247][248][249] The populations predominantly but not exclusively included patients undergoing peripheral vascular surgical procedures. Only 2 studies blinded the physicians and surgeons who treated the patients to the dobutamine stress echocardiography results.…”

“…Only 2 studies blinded the physicians and surgeons who treated the patients to the dobutamine stress echocardiography results. 160,239 In the remaining studies, the results were used to influence preoperative management, particularly the decision whether or not to proceed with coronary angiography or coronary revascularization before elective surgery. Each study used similar but not identical protocols.…”