Patients undergoing peripheral vascular surgery are at increased risk of postoperative cardiac complications. To evaluate the role of dipyridamole echocardiography in predicting major cardiac events, 109 unselected patients undergoing elective peripheral vascular surgery were prospectively studied. Preoperative dipyridamole echocardiograms were interpreted by an echocardiographer unaware of all clinical data. Patients were followed up until hospital discharge by research physicians without knowledge of dipyridamole echocardiography results. Outcomes were classified using strict predefined criteria by reviewers unaware of other clinical and echocardiographic data. Of the 109 patients, 9 (8%) had positive studies defined as development of new regional wall motion abnormalities or worsening of preexistent wall motion abnormalities. Of these 9 patients, 7 had postoperative events, including 3 cardiac deaths, 1 nonfatal myocardial infarction, 2 with unstable angina, and 1 with pulmonary edema. Only 1 event occurred among the 100 patients with negative studies. The sensitivity and specificity of dipyridamole echocardiography for predicting cardiac events after vascular surgery were 88 and 98%, respectively; the positive and negative predictive values were 78 and 99%. The relative risk of having a cardiac event if dipyridamole echocardiography was abnormal was 78 (95% confidence interval, 11 to 564; p < 0.0001). If these results are extended and confirmed by other investigators, preoperative dipyridamole echocardiography may be an important screening test for patients undergoing elective peripheral vascular surgery.
Bibliographical noteFunding Information:
From the Cardiovascular Division and the Divisions of Clinical Epidemiology and General Medicine, Brigham and Women’sH ospital, Harvard Medical School, Boston, Massachusetts.D r. Richard T. Lee is a recipient of Physician Scientist Award HL-01835 and Dr. Mark A. Creager is a recipient of Research Career Development Award HL-01768 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland. Dr. Thomas H. Lee is a recipient of an Established Investigator award (900119) from the American Heart Association, Dallas, Texas. Dr. Alan Hirsch is a recipient of an individual National Research Service award (F32-HL-07702), Bethesda, Maryland. Manuscript receivedM arch 14,199l; revisedm anuscript receiveda nd accepted April 29, 1991.