Objectives This study sought to evaluate the negative predictive value( NPV) of preoperative dobutamine stress echocardiography(DSE) in patients who fail to ac hieve target heart rate(HR) and assess the influence of r...Objectives This study sought to evaluate the negative predictive value( NPV) of preoperative dobutamine stress echocardiography(DSE) in patients who fail to ac hieve target heart rate(HR) and assess the influence of resting wall motion abno rmalities(WMAs) without demonstrable ischemia on perioperative events. Backgroun d The prognostic value of a negative-submaximal DSE study before noncardiac sur gery is unknown. Methods Consecutive patients (n=429) who underwent surgery over a three-year period, preceded by DSE, were included. We compared perioperative event rates among those without inducible ischemia according to whether or not 85%age-adjusted maximum HR was achieved, and whether WMAs were present at rest . Results Of 397 negative DSEs, peak HR was < 85%maximum predicted in 62 (16%) . Most were receiving beta-blockers (77%). The average dobutamine and atropine doses were 48 μg/kg/min and 1.2 mg, respectively. Average HR was 115 beats/min (74%maximum predicted). Perioperative myocardial infarctions occurred more fre quently in patients with positive tests (3 of 32 <<9.4%>> vs. 7 of 397 <<1.8%>>; p =0.03) , but with similar frequency among the negative-maximal and negative-su bmaximal groups(6 of 335, 1.8%vs. 1 of 62, 1.6%, respectively). Accordingly, t he NPV was 98%in both subgroups. Events occurred exclusively in patients with W MAs at rest: 7 of 100 (7%) versus 0 of 297 (0%) (p < 0.0001). Conclusions In p atients undergoing preoperative DSE, failure to achieve target HR is not uncommo n despite an aggressive DSE regimen. A negative DSE without resting WMAs has exc ellent NPV regardless of the HR achieved. Patients with resting WMAs appear to b e at increased risk for perioperative events even without provokable ischemia.展开更多
文摘Objectives This study sought to evaluate the negative predictive value( NPV) of preoperative dobutamine stress echocardiography(DSE) in patients who fail to ac hieve target heart rate(HR) and assess the influence of resting wall motion abno rmalities(WMAs) without demonstrable ischemia on perioperative events. Backgroun d The prognostic value of a negative-submaximal DSE study before noncardiac sur gery is unknown. Methods Consecutive patients (n=429) who underwent surgery over a three-year period, preceded by DSE, were included. We compared perioperative event rates among those without inducible ischemia according to whether or not 85%age-adjusted maximum HR was achieved, and whether WMAs were present at rest . Results Of 397 negative DSEs, peak HR was < 85%maximum predicted in 62 (16%) . Most were receiving beta-blockers (77%). The average dobutamine and atropine doses were 48 μg/kg/min and 1.2 mg, respectively. Average HR was 115 beats/min (74%maximum predicted). Perioperative myocardial infarctions occurred more fre quently in patients with positive tests (3 of 32 <<9.4%>> vs. 7 of 397 <<1.8%>>; p =0.03) , but with similar frequency among the negative-maximal and negative-su bmaximal groups(6 of 335, 1.8%vs. 1 of 62, 1.6%, respectively). Accordingly, t he NPV was 98%in both subgroups. Events occurred exclusively in patients with W MAs at rest: 7 of 100 (7%) versus 0 of 297 (0%) (p < 0.0001). Conclusions In p atients undergoing preoperative DSE, failure to achieve target HR is not uncommo n despite an aggressive DSE regimen. A negative DSE without resting WMAs has exc ellent NPV regardless of the HR achieved. Patients with resting WMAs appear to b e at increased risk for perioperative events even without provokable ischemia.
