|
ACC/AHA
Guideline Update for Perioperative Cardiovascular Evaluation
for Noncardiac Surgery
A
Report of the American College of Cardiology/American
Heart Association Task Force on Practice Guidelines
(Committee to Update the 1996 Guidelines on Perioperative
Cardiovascular Evaluation for Noncardiac Surgery)
(Printer-friendly
version)
Revised
Table 8. Summary
of Studies Examining the Value of Dobutamine Stress
Echocardiography for Preoperative Risk Assessment
|
Author
|
N*
|
Patients
With Ischemia, %
|
Events
MI/Death,
%
|
Criteria
for
Abnormal
Test
|
Positive
Predictive Value†
for
MI or Death
|
Negative
Predictive Value
|
Comments
|
|
Lane
1991 (147)
|
38
|
50
|
3
(8)
|
New
WMA
|
16%
(3/19)
|
100%
(19/19)
|
Vascular
and general surgery
|
|
Lalka
1992 (148)
|
60
|
50
|
9
(15)
|
New
or worsening
WMA
|
23%
(7/30)
|
93%
(28/30)
|
Multivariate
analysis
|
|
Eichelberger
1993 (149)
|
75
|
36
|
2
(3)
|
New
or worsening
WMA
|
7%
(2/27)
|
100%
(48/48)
|
Managing
physicians blinded to DSE results
|
|
Langan
1993 (150)
|
74
|
24
|
3
(4)
|
New
WMA or
ECG
changes
|
17%
(3/18)
|
100%
(56/56)
|
|
|
Poldermans
1993 (105)
|
131
|
27
|
5
(4)
|
New
or worsening
WMA
|
14%
(5/35)
|
100%
(96/96)
|
Multivariate
analysis; managing physicians blinded to DSE results
|
|
Dávila
Román 1993 (151)
|
88
|
23
|
2
(2)
|
New
or worsening
WMA
|
10%
(2/20)
|
100%
(68/68)
|
Included
long-term follow-up
|
|
Poldermans
1995 (286)
|
302
|
24
|
17
(6)
|
New
or worsening WMA
|
24%
(17/72)
|
100%
(228/228)
|
Multivariate
analysis
|
|
Shafritz
1997 (287)
|
42
|
0
|
1
(2)
|
New
or worsening WMA
|
NA
|
97%
(41/42)
|
|
|
Plotkin
1998 (263)
|
80
|
8
|
2
(3)
|
New
or worsening WMA, ECG changes, and/or symptoms
of chest pain or dyspnea
|
33%
(2/6)
|
100%
(74/74)
|
Orthotopic
liver transplantation
|
|
Ballal
1999 (288)
|
233
|
17
|
7
(3)
|
New
or worsening WMA
|
0%
(0/39)‡
|
96%
(187/194)
|
Included
long-term follow-up
|
|
Bossone
1999 (266)
|
46
|
9
|
1
(2)
|
New
or worsening WMA
|
25%
(1/4)
|
100%
(42/42)
|
Lung
volume reduction surgery;
Included
long-term follow-up
|
|
Das
2000 (289)
|
530
|
40
|
32
(6)
|
New
or worsening WMA or failure to develop hyperdynamic
function
|
15%
(32/214)
|
100%
(316/316)
|
Multivariate
analysis;
Nonvascular
surgery
|
DSE
indicates dobutamine stress echocardiogram; ECG, electrocardiogram;
MI, myocardial infarction; NA, not available; WMA, wall-motion
abnormality.
*Number
of patients who underwent surgery.
†Numbers
in parentheses refer to number of patients/total in
group.
‡
Intervening revascularization in 9 (23%) of ischemic
patients.
|
