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EAGLE ET AL., PERIOPERATIVE CARDIOVASCULAR EVALUATION FOR NONCARDIAC SURGERY UPDATE
http://www.acc.org/clinical/guidelines/perio/update/periupdate_index.htm

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)

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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.

 

Copyright © 2002 by the American College of Cardiology and American Heart Association, Inc.

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