Preoperative Dobutamine Stress Echocardiography and Clinical Factors for Assessment of Cardiac Risk after Noncardiac Surgery

Michael W. Cullen; Robert B. McCully; R. Jay Widmer; Darrell R. Schroeder; Bradley R. Salonen; David Raslau; Karna K. Sundsted; Arya B. Mohabbat; Brian M. Dougan; Dennis M. Bierle; Andrew Widmer; Dipti Banerjee; Prakriti Gaba; Rene Tellez; Garvan C. Kane; Patricia A. Pellikka; Karen F. Mauck

doi:10.1016/j.echo.2019.11.015

Preoperative Dobutamine Stress Echocardiography and Clinical Factors for Assessment of Cardiac Risk after Noncardiac Surgery

Michael W. Cullen, Robert B. McCully, R. Jay Widmer, Darrell R. Schroeder, Bradley R. Salonen, David Raslau, Karna K. Sundsted, Arya B. Mohabbat, Brian M. Dougan, Dennis M. Bierle, Andrew Widmer, Dipti Banerjee, Prakriti Gaba, Rene Tellez, Garvan C. Kane, Patricia A. Pellikka, Karen F. Mauck

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: The role of dobutamine stress echocardiography (DSE) in the risk stratification of patients undergoing noncardiac surgery in the current era is unclear. The aim of this study was to evaluate the yield of DSE and the additive role of DSE to clinical criteria for preoperative risk stratification of patients undergoing noncardiac surgery. Methods: The study included 4,494 patients undergoing DSE ≤90 days before noncardiac surgery. The primary outcome was a composite of postoperative myocardial infarction, cardiac arrest, and all-cause mortality ≤30 days after noncardiac surgery. Results: The overall 30-day postoperative cardiac event rate was 2.3%. The mortality rate was 0.9% overall and 0.7% and 1.3% after normal and abnormal results on DSE, respectively. Among clinical variables, the modified Revised Cardiac Risk Index score demonstrated the strongest association with postoperative risk (P < .001). Patients with Revised Cardiac Risk Index scores of ≥3 had an event rate of 7.5%. The event rates for patients with wall motion score index ≥1.7 at baseline, left ventricular ejection fractions <40% at peak stress, or ischemic thresholds <70% of age-predicted maximal heart rate were 7.1%, 8.6%, and 7.9%, respectively. After adjusting for clinical variables, the overall result of DSE (P < .001), baseline and peak-stress wall motion score index (P < .001 and P = .014, respectively), peak-stress left ventricular ejection fraction (P < .001), and the number of ischemic segments (P = .027) were all associated with postoperative cardiac events. Incremental multivariate analysis demonstrated that an overall abnormal result on DSE, added to clinical variables, was associated with an increased risk for postoperative cardiac events (odds ratio, 2.07; 95% CI, 1.35–3.17; P < .001). Conclusions: Baseline and peak-stress findings on preoperative DSE add to the prognostic utility of clinical variables for stratifying cardiac risk after noncardiac surgery.

Original language	English (US)
Pages (from-to)	423-432
Number of pages	10
Journal	Journal of the American Society of Echocardiography
Volume	33
Issue number	4
DOIs	https://doi.org/10.1016/j.echo.2019.11.015
State	Published - Apr 2020

Keywords

Dobutamine stress echocardiography
Noncardiac surgery
Preoperative evaluation

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

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10.1016/j.echo.2019.11.015

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Cullen, M. W., McCully, R. B., Widmer, R. J., Schroeder, D. R., Salonen, B. R., Raslau, D., Sundsted, K. K., Mohabbat, A. B., Dougan, B. M., Bierle, D. M., Widmer, A., Banerjee, D., Gaba, P., Tellez, R., Kane, G. C., Pellikka, P. A., & Mauck, K. F. (2020). Preoperative Dobutamine Stress Echocardiography and Clinical Factors for Assessment of Cardiac Risk after Noncardiac Surgery. Journal of the American Society of Echocardiography, 33(4), 423-432. https://doi.org/10.1016/j.echo.2019.11.015

Cullen, MW, McCully, RB, Widmer, RJ, Schroeder, DR, Salonen, BR, Raslau, D, Sundsted, KK, Mohabbat, AB, Dougan, BM, Bierle, DM, Widmer, A, Banerjee, D, Gaba, P, Tellez, R, Kane, GC , Pellikka, PA & Mauck, KF 2020, 'Preoperative Dobutamine Stress Echocardiography and Clinical Factors for Assessment of Cardiac Risk after Noncardiac Surgery', Journal of the American Society of Echocardiography, vol. 33, no. 4, pp. 423-432. https://doi.org/10.1016/j.echo.2019.11.015

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title = "Preoperative Dobutamine Stress Echocardiography and Clinical Factors for Assessment of Cardiac Risk after Noncardiac Surgery",

abstract = "Background: The role of dobutamine stress echocardiography (DSE) in the risk stratification of patients undergoing noncardiac surgery in the current era is unclear. The aim of this study was to evaluate the yield of DSE and the additive role of DSE to clinical criteria for preoperative risk stratification of patients undergoing noncardiac surgery. Methods: The study included 4,494 patients undergoing DSE ≤90 days before noncardiac surgery. The primary outcome was a composite of postoperative myocardial infarction, cardiac arrest, and all-cause mortality ≤30 days after noncardiac surgery. Results: The overall 30-day postoperative cardiac event rate was 2.3%. The mortality rate was 0.9% overall and 0.7% and 1.3% after normal and abnormal results on DSE, respectively. Among clinical variables, the modified Revised Cardiac Risk Index score demonstrated the strongest association with postoperative risk (P < .001). Patients with Revised Cardiac Risk Index scores of ≥3 had an event rate of 7.5%. The event rates for patients with wall motion score index ≥1.7 at baseline, left ventricular ejection fractions <40% at peak stress, or ischemic thresholds <70% of age-predicted maximal heart rate were 7.1%, 8.6%, and 7.9%, respectively. After adjusting for clinical variables, the overall result of DSE (P < .001), baseline and peak-stress wall motion score index (P < .001 and P = .014, respectively), peak-stress left ventricular ejection fraction (P < .001), and the number of ischemic segments (P = .027) were all associated with postoperative cardiac events. Incremental multivariate analysis demonstrated that an overall abnormal result on DSE, added to clinical variables, was associated with an increased risk for postoperative cardiac events (odds ratio, 2.07; 95% CI, 1.35–3.17; P < .001). Conclusions: Baseline and peak-stress findings on preoperative DSE add to the prognostic utility of clinical variables for stratifying cardiac risk after noncardiac surgery.",

keywords = "Dobutamine stress echocardiography, Noncardiac surgery, Preoperative evaluation",

author = "Cullen, {Michael W.} and McCully, {Robert B.} and Widmer, {R. Jay} and Schroeder, {Darrell R.} and Salonen, {Bradley R.} and David Raslau and Sundsted, {Karna K.} and Mohabbat, {Arya B.} and Dougan, {Brian M.} and Bierle, {Dennis M.} and Andrew Widmer and Dipti Banerjee and Prakriti Gaba and Rene Tellez and Kane, {Garvan C.} and Pellikka, {Patricia A.} and Mauck, {Karen F.}",

note = "Publisher Copyright: {\textcopyright} 2019 American Society of Echocardiography",

year = "2020",

month = apr,

doi = "10.1016/j.echo.2019.11.015",

language = "English (US)",

volume = "33",

pages = "423--432",

journal = "Journal of the American Society of Echocardiography",

issn = "0894-7317",

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number = "4",

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TY - JOUR

T1 - Preoperative Dobutamine Stress Echocardiography and Clinical Factors for Assessment of Cardiac Risk after Noncardiac Surgery

AU - Cullen, Michael W.

AU - McCully, Robert B.

AU - Widmer, R. Jay

AU - Schroeder, Darrell R.

AU - Salonen, Bradley R.

AU - Raslau, David

AU - Sundsted, Karna K.

AU - Mohabbat, Arya B.

AU - Dougan, Brian M.

AU - Bierle, Dennis M.

AU - Widmer, Andrew

AU - Banerjee, Dipti

AU - Gaba, Prakriti

AU - Tellez, Rene

AU - Kane, Garvan C.

AU - Pellikka, Patricia A.

AU - Mauck, Karen F.

PY - 2020/4

Y1 - 2020/4

N2 - Background: The role of dobutamine stress echocardiography (DSE) in the risk stratification of patients undergoing noncardiac surgery in the current era is unclear. The aim of this study was to evaluate the yield of DSE and the additive role of DSE to clinical criteria for preoperative risk stratification of patients undergoing noncardiac surgery. Methods: The study included 4,494 patients undergoing DSE ≤90 days before noncardiac surgery. The primary outcome was a composite of postoperative myocardial infarction, cardiac arrest, and all-cause mortality ≤30 days after noncardiac surgery. Results: The overall 30-day postoperative cardiac event rate was 2.3%. The mortality rate was 0.9% overall and 0.7% and 1.3% after normal and abnormal results on DSE, respectively. Among clinical variables, the modified Revised Cardiac Risk Index score demonstrated the strongest association with postoperative risk (P < .001). Patients with Revised Cardiac Risk Index scores of ≥3 had an event rate of 7.5%. The event rates for patients with wall motion score index ≥1.7 at baseline, left ventricular ejection fractions <40% at peak stress, or ischemic thresholds <70% of age-predicted maximal heart rate were 7.1%, 8.6%, and 7.9%, respectively. After adjusting for clinical variables, the overall result of DSE (P < .001), baseline and peak-stress wall motion score index (P < .001 and P = .014, respectively), peak-stress left ventricular ejection fraction (P < .001), and the number of ischemic segments (P = .027) were all associated with postoperative cardiac events. Incremental multivariate analysis demonstrated that an overall abnormal result on DSE, added to clinical variables, was associated with an increased risk for postoperative cardiac events (odds ratio, 2.07; 95% CI, 1.35–3.17; P < .001). Conclusions: Baseline and peak-stress findings on preoperative DSE add to the prognostic utility of clinical variables for stratifying cardiac risk after noncardiac surgery.

AB - Background: The role of dobutamine stress echocardiography (DSE) in the risk stratification of patients undergoing noncardiac surgery in the current era is unclear. The aim of this study was to evaluate the yield of DSE and the additive role of DSE to clinical criteria for preoperative risk stratification of patients undergoing noncardiac surgery. Methods: The study included 4,494 patients undergoing DSE ≤90 days before noncardiac surgery. The primary outcome was a composite of postoperative myocardial infarction, cardiac arrest, and all-cause mortality ≤30 days after noncardiac surgery. Results: The overall 30-day postoperative cardiac event rate was 2.3%. The mortality rate was 0.9% overall and 0.7% and 1.3% after normal and abnormal results on DSE, respectively. Among clinical variables, the modified Revised Cardiac Risk Index score demonstrated the strongest association with postoperative risk (P < .001). Patients with Revised Cardiac Risk Index scores of ≥3 had an event rate of 7.5%. The event rates for patients with wall motion score index ≥1.7 at baseline, left ventricular ejection fractions <40% at peak stress, or ischemic thresholds <70% of age-predicted maximal heart rate were 7.1%, 8.6%, and 7.9%, respectively. After adjusting for clinical variables, the overall result of DSE (P < .001), baseline and peak-stress wall motion score index (P < .001 and P = .014, respectively), peak-stress left ventricular ejection fraction (P < .001), and the number of ischemic segments (P = .027) were all associated with postoperative cardiac events. Incremental multivariate analysis demonstrated that an overall abnormal result on DSE, added to clinical variables, was associated with an increased risk for postoperative cardiac events (odds ratio, 2.07; 95% CI, 1.35–3.17; P < .001). Conclusions: Baseline and peak-stress findings on preoperative DSE add to the prognostic utility of clinical variables for stratifying cardiac risk after noncardiac surgery.

KW - Dobutamine stress echocardiography

KW - Noncardiac surgery

KW - Preoperative evaluation

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ER -

Preoperative Dobutamine Stress Echocardiography and Clinical Factors for Assessment of Cardiac Risk after Noncardiac Surgery

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