Tischler M D, Lee T H, Hirsch A T, Lord C P, Goldman L, Creager M A, Lee R T
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
Am J Cardiol. 1991 Sep 1;68(6):593-7. doi: 10.1016/0002-9149(91)90349-p.
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 less than 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.
接受外周血管手术的患者术后发生心脏并发症的风险增加。为评估双嘧达莫超声心动图在预测主要心脏事件中的作用，对109例未经挑选的接受择期外周血管手术的患者进行了前瞻性研究。术前双嘧达莫超声心动图由一名不了解所有临床资料的超声心动图医师解读。患者由不了解双嘧达莫超声心动图结果的研究医师随访至出院。结局由不了解其他临床和超声心动图资料的评审人员按照严格预先定义的标准进行分类。在这109例患者中，9例（8%）检查结果为阳性，定义为出现新的局部室壁运动异常或原有室壁运动异常加重。在这9例患者中，7例发生了术后事件，包括3例心源性死亡、1例非致命性心肌梗死、2例不稳定型心绞痛和1例肺水肿。在100例检查结果为阴性的患者中仅发生了1例事件。双嘧达莫超声心动图预测血管手术后心脏事件的敏感性和特异性分别为88%和98%；阳性预测值和阴性预测值分别为78%和99%。双嘧达莫超声心动图异常时发生心脏事件的相对风险为78（95%置信区间，11至564；P<0.0001）。如果这些结果能被其他研究者推广和证实，术前双嘧达莫超声心动图可能会成为接受择期外周血管手术患者的一项重要筛查检查。
