Negative predictive Value of Dobutamine Stress Echocardiography for Perioperative Risk Stratification in Patients with Cardiac Risk Factors and Reduced Exercise Capacity undergoing Non-cardiac Surgery.

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Negative predictive Value of Dobutamine Stress Echocardiography for Perioperative Risk Stratification in Patients with Cardiac Risk Factors and Reduced Exercise Capacity undergoing Non-cardiac Surgery.

Intern Med J. 2017 Oct 02;:

Authors: Go G, Davies KT, O'Callaghan C, Senior W, Kostner K, Fagermo N, Prasad SB

Abstract
BACKGROUND: Guidelines recommend functional testing for myocardial ischaemia in the perioperative setting in patients with >1 recognised cardiac risk factors and self-reported reduced exercise capacity. We sought to determine the clinical utility of dobutamine stress echocardiography (DSE) for perioperative risk stratification in patients undergoing major noncardiac surgery.
METHODS: Data on 79 consecutive patients undergoing DSE for perioperative risk stratification at a single centre was retrospectively reviewed to determine rates of Major Adverse Cardiac Events (MACE) during the index hospitalisation and 30 days post discharge. Echocardiography and outcomes data were obtained via folder audit and echolab database.
RESULTS: Out of the 79 DSEs performed for perioperative risk stratification, 11(14%) were positive (DSE+ve) and 68(86%) were negative (DSE-ve). Management in the DSE+ve group included medical optimisation without invasive intervention [n=7(64%)], diagnostic coronary angiography [n=3(27%)], and coronary artery bypass graft [n=1(9%)]. None of the patients underwent percutaneous coronary intervention pre-operatively. Perioperative MACE in the DSE+ve group was 36% compared to 4% in the DSE-ve group (p=0.006). DSE+ve was a powerful predictor of perioperative inpatient MACE (OR 12.4, 95% CI 2.3-67, p=0.003). The positive predictive value of DSE+ve status was 36%, whist the negative predictive value of DSE-ve status for perioperative MACE was 96%.
CONCLUSION: DSE for perioperative risk stratification had a high clinical utility in patients undergoing major noncardiac surgery. In particular, a normal DSE had a high negative predictive value for perioperative MACE.

PMID: 28967164 [PubMed - as supplied by publisher]

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