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

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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 languageEnglish (US)
JournalJournal of the American Society of Echocardiography
DOIs
StateAccepted/In press - Jan 1 2020

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Keywords

  • Dobutamine stress echocardiography
  • Noncardiac surgery
  • Preoperative evaluation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

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. (Accepted/In press). Preoperative Dobutamine Stress Echocardiography and Clinical Factors for Assessment of Cardiac Risk after Noncardiac Surgery. Journal of the American Society of Echocardiography. https://doi.org/10.1016/j.echo.2019.11.015