Comparative prognostic value of clinical risk indexes, resting two-dimensional echocardiography, and dipyridamole stress thallium-201 myocardial imaging for perioperative cardiac events in major nonvascular surgery patients

Bonpei Takase, Liwa T. Younis, Sheila L. Byers, Leslee J. Shaw, Arthur J. Labovitz, Bernard R. Chaitman, Donald D Miller

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

The relative prognostic value of widely accessible resting two-dimensional echocardiographic ventricular function data has not been compared with recognized clinical and scintigraphic risk markers in patients who are unable to exercise before major nonvascular surgery. To this end, 53 consecutive patients aged 67 ± 13 years undergoing preoperative evaluation (intraabdominal, 23%; orthopedic, 30%; thoracic, 9%; other, 38%) for known or suspected coronary artery disease were followed up to evaluate the prognostic value of these studies for the perioperative cardiac events (cardiac death [n = 4], myocardial infarction [n = 2], unstable angina [n = 3], and pulmonary edema [n = 8]) that occurred in 13 of the 53 patients (25%). Dipyridamole thallium-201 myocardial redistribution defects occurred in 15 (28%) patients. Resting echocardiographic left ventricular dysfunction was present in 21 (40%) patients. Multivariate analysis of clinical, echocardiographic, and scintigraphic risk predictors revealed that cardiac events were not predicted by clinical variables, including Goldman class or score. Cardiac events were independently predicted only by the presence of significant left ventricular dysfunction on resting two-dimensional echocardiography (p < 0.042) and dipyridamole thallium-201 defect redistribution (p < 0.026). A dipyridamole-induced reversible thallium-201 perfusion defect was predictive of subsequent cardiac death or myocardial infarction (p < 0.02), whereas left ventricular dysfunction on resting echocardiography was predictive of perioperative pulmonary edema (p < 0.023). We conclude that stress thallium-201 perfusion imaging and resting two-dimensional echocardiography provide independent prognostic information in patients undergoing major nonvascular surgery who are at significant risk for ischemic cardiac events and who are unable to perform standard exercise stress tests. Clinical risk indexes were not predictive of cardiac events in these patients when analyzed in combination with noninvasive risk assessment.

Original languageEnglish (US)
Pages (from-to)1099-1106
Number of pages8
JournalAmerican Heart Journal
Volume126
Issue number5
DOIs
StatePublished - Jan 1 1993
Externally publishedYes

Fingerprint

Dipyridamole
Thallium
Echocardiography
Left Ventricular Dysfunction
Pulmonary Edema
Exercise Test
Myocardial Infarction
Perfusion Imaging
Ventricular Function
Unstable Angina
Orthopedics
Coronary Artery Disease
Thorax
Multivariate Analysis
Perfusion
Exercise

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparative prognostic value of clinical risk indexes, resting two-dimensional echocardiography, and dipyridamole stress thallium-201 myocardial imaging for perioperative cardiac events in major nonvascular surgery patients. / Takase, Bonpei; Younis, Liwa T.; Byers, Sheila L.; Shaw, Leslee J.; Labovitz, Arthur J.; Chaitman, Bernard R.; Miller, Donald D.

In: American Heart Journal, Vol. 126, No. 5, 01.01.1993, p. 1099-1106.

Research output: Contribution to journalArticle

@article{9fdd874f7ace4c5d831607637c9109ea,
title = "Comparative prognostic value of clinical risk indexes, resting two-dimensional echocardiography, and dipyridamole stress thallium-201 myocardial imaging for perioperative cardiac events in major nonvascular surgery patients",
abstract = "The relative prognostic value of widely accessible resting two-dimensional echocardiographic ventricular function data has not been compared with recognized clinical and scintigraphic risk markers in patients who are unable to exercise before major nonvascular surgery. To this end, 53 consecutive patients aged 67 ± 13 years undergoing preoperative evaluation (intraabdominal, 23{\%}; orthopedic, 30{\%}; thoracic, 9{\%}; other, 38{\%}) for known or suspected coronary artery disease were followed up to evaluate the prognostic value of these studies for the perioperative cardiac events (cardiac death [n = 4], myocardial infarction [n = 2], unstable angina [n = 3], and pulmonary edema [n = 8]) that occurred in 13 of the 53 patients (25{\%}). Dipyridamole thallium-201 myocardial redistribution defects occurred in 15 (28{\%}) patients. Resting echocardiographic left ventricular dysfunction was present in 21 (40{\%}) patients. Multivariate analysis of clinical, echocardiographic, and scintigraphic risk predictors revealed that cardiac events were not predicted by clinical variables, including Goldman class or score. Cardiac events were independently predicted only by the presence of significant left ventricular dysfunction on resting two-dimensional echocardiography (p < 0.042) and dipyridamole thallium-201 defect redistribution (p < 0.026). A dipyridamole-induced reversible thallium-201 perfusion defect was predictive of subsequent cardiac death or myocardial infarction (p < 0.02), whereas left ventricular dysfunction on resting echocardiography was predictive of perioperative pulmonary edema (p < 0.023). We conclude that stress thallium-201 perfusion imaging and resting two-dimensional echocardiography provide independent prognostic information in patients undergoing major nonvascular surgery who are at significant risk for ischemic cardiac events and who are unable to perform standard exercise stress tests. Clinical risk indexes were not predictive of cardiac events in these patients when analyzed in combination with noninvasive risk assessment.",
author = "Bonpei Takase and Younis, {Liwa T.} and Byers, {Sheila L.} and Shaw, {Leslee J.} and Labovitz, {Arthur J.} and Chaitman, {Bernard R.} and Miller, {Donald D}",
year = "1993",
month = "1",
day = "1",
doi = "10.1016/0002-8703(93)90660-2",
language = "English (US)",
volume = "126",
pages = "1099--1106",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "5",

}

TY - JOUR

T1 - Comparative prognostic value of clinical risk indexes, resting two-dimensional echocardiography, and dipyridamole stress thallium-201 myocardial imaging for perioperative cardiac events in major nonvascular surgery patients

AU - Takase, Bonpei

AU - Younis, Liwa T.

AU - Byers, Sheila L.

AU - Shaw, Leslee J.

AU - Labovitz, Arthur J.

AU - Chaitman, Bernard R.

AU - Miller, Donald D

PY - 1993/1/1

Y1 - 1993/1/1

N2 - The relative prognostic value of widely accessible resting two-dimensional echocardiographic ventricular function data has not been compared with recognized clinical and scintigraphic risk markers in patients who are unable to exercise before major nonvascular surgery. To this end, 53 consecutive patients aged 67 ± 13 years undergoing preoperative evaluation (intraabdominal, 23%; orthopedic, 30%; thoracic, 9%; other, 38%) for known or suspected coronary artery disease were followed up to evaluate the prognostic value of these studies for the perioperative cardiac events (cardiac death [n = 4], myocardial infarction [n = 2], unstable angina [n = 3], and pulmonary edema [n = 8]) that occurred in 13 of the 53 patients (25%). Dipyridamole thallium-201 myocardial redistribution defects occurred in 15 (28%) patients. Resting echocardiographic left ventricular dysfunction was present in 21 (40%) patients. Multivariate analysis of clinical, echocardiographic, and scintigraphic risk predictors revealed that cardiac events were not predicted by clinical variables, including Goldman class or score. Cardiac events were independently predicted only by the presence of significant left ventricular dysfunction on resting two-dimensional echocardiography (p < 0.042) and dipyridamole thallium-201 defect redistribution (p < 0.026). A dipyridamole-induced reversible thallium-201 perfusion defect was predictive of subsequent cardiac death or myocardial infarction (p < 0.02), whereas left ventricular dysfunction on resting echocardiography was predictive of perioperative pulmonary edema (p < 0.023). We conclude that stress thallium-201 perfusion imaging and resting two-dimensional echocardiography provide independent prognostic information in patients undergoing major nonvascular surgery who are at significant risk for ischemic cardiac events and who are unable to perform standard exercise stress tests. Clinical risk indexes were not predictive of cardiac events in these patients when analyzed in combination with noninvasive risk assessment.

AB - The relative prognostic value of widely accessible resting two-dimensional echocardiographic ventricular function data has not been compared with recognized clinical and scintigraphic risk markers in patients who are unable to exercise before major nonvascular surgery. To this end, 53 consecutive patients aged 67 ± 13 years undergoing preoperative evaluation (intraabdominal, 23%; orthopedic, 30%; thoracic, 9%; other, 38%) for known or suspected coronary artery disease were followed up to evaluate the prognostic value of these studies for the perioperative cardiac events (cardiac death [n = 4], myocardial infarction [n = 2], unstable angina [n = 3], and pulmonary edema [n = 8]) that occurred in 13 of the 53 patients (25%). Dipyridamole thallium-201 myocardial redistribution defects occurred in 15 (28%) patients. Resting echocardiographic left ventricular dysfunction was present in 21 (40%) patients. Multivariate analysis of clinical, echocardiographic, and scintigraphic risk predictors revealed that cardiac events were not predicted by clinical variables, including Goldman class or score. Cardiac events were independently predicted only by the presence of significant left ventricular dysfunction on resting two-dimensional echocardiography (p < 0.042) and dipyridamole thallium-201 defect redistribution (p < 0.026). A dipyridamole-induced reversible thallium-201 perfusion defect was predictive of subsequent cardiac death or myocardial infarction (p < 0.02), whereas left ventricular dysfunction on resting echocardiography was predictive of perioperative pulmonary edema (p < 0.023). We conclude that stress thallium-201 perfusion imaging and resting two-dimensional echocardiography provide independent prognostic information in patients undergoing major nonvascular surgery who are at significant risk for ischemic cardiac events and who are unable to perform standard exercise stress tests. Clinical risk indexes were not predictive of cardiac events in these patients when analyzed in combination with noninvasive risk assessment.

UR - http://www.scopus.com/inward/record.url?scp=0027493038&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027493038&partnerID=8YFLogxK

U2 - 10.1016/0002-8703(93)90660-2

DO - 10.1016/0002-8703(93)90660-2

M3 - Article

VL - 126

SP - 1099

EP - 1106

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

IS - 5

ER -