Effectiveness and need for follow-up invasive testing in patients undergoing initial preoperative evaluation with dobutamine stress echocardiography compared to persantine thallium

Rafer Leach*, Stephen Devries

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Identification of patients at risk for cardiac complications from surgery using traditional methods of stress testing with nuclear imaging can be challenging and expensive. Objective: The purpose of this study was to compare the effectiveness and need for additional cardiac tests when stress testing prior to noncardiac surgery was performed with persantine thallium (PerT) compared to initial testing with dobutamine stress echocardiography (DSE). Methods: A retrospective review of all patients undergoing noncardiac surgery over a 3 year period was undertaken in which the initial cardiac study performed prior to surgery was either DSE or PerT. Results: A total of 262 pts underwent either DSE (n=168, age=64) or PerT (n = 94, age=63) prior to surgery. A negative DSE or PerT was highly predictive of a perioperative course free from myocardial infarction (1 pt with DSE, 0 pt with PerT) or cardiac death (0 DSE, 0 PerT). Patients undergoing PerT, however, were significantly more likely to undergo follow-up testing with cardiac catheterization (41%) than those initially tested with DSE (22%), p<0.001. The rate of false positive exams was 30% for DSE and 44% for PerT, p=ns. Summary: No difference was found in the ability to stratify risk of ischemic perioperative cardiac complications in patients studied with DSE or PerT. Nevertheless, the strategy of initial testing with PerT was associated with nearly a two-fold increase in the likelihood of undergoing follow-up testing with cardiac catheterization. Conclusion: Increasing the utilization of DSE over PerT for preoperative evaluation may be a useful strategy to effectively stratify cardiac risk while reducing cost and morbidity by decreasing the likelihood of follow-up testing with cardiac catheterization.

Original languageEnglish (US)
Number of pages1
JournalJournal of the American Society of Echocardiography
Volume10
Issue number4
StatePublished - Dec 1 1997

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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