Sicari R, Picano E, Lusa A M, Salustri A, Ciavatti M, Del Rosso G, Kozakova M, Ferrari M, Pedrinelli R, Pingitore A
Eur Heart J. 1995 Jun;16(6):842-7. doi: 10.1093/oxfordjournals.eurheartj.a061004.
Patients undergoing major vascular surgery are at relatively high risk of cardiac events, and pharmacological stress echocardiography is increasingly used for peri-operative risk stratification.
One hundred and twenty-one patients undergoing vascular surgery (age 65 +/- 7 years) were studied by dipyridamole echocardiography testing in six different centres. Of the total 136 patients, 15 were subsequently excluded because surgery was either cancelled (n = 8) or postponed pending cardiac revascularization (n = 7) because of the presence of a 'high-risk' stress echo response (identified 'a priori' as a positive dipyridamole echocardiography testing with a dipyridamole-time < 5 min and/or a peak wall motion score index > 2, upon scoring each segment from 1 = normal to 4 = dyskinetic in an 11-segment model).
No major complications occurred during dipyridamole echocardiography testing. Technically adequate images were obtained in all patients; however, in one patient only the low dipyridamole dose (56 mg.kg-1 over 4 min) was given to limit side effects. Of the 121 patients undergoing surgery 28 (23%) had a positive test. Peri-operative events occurred in nine patients (8%): two deaths, two myocardial infarctions, five cases of unstable angina. Sensitivity and specificity of dipyridamole echocardiography testing for predicting cardiac events were 78% and 81%, respectively, with a positive predictive value of 25% and a negative predictive value of 98%. Dipyridamole echocardiography testing effectively singled out patients with, from those without, events, but neither clinical parameters, such as Detsky score, nor baseline echo parameters, such as resting wall motion score index or ejection fraction were able to distinguish between such patients.
In conclusion, dipyridamole echocardiography testing is safe and well tolerated in patients undergoing major vascular surgery, and provides an effective pre-operative screening test for risk stratification of these patients mainly due to the extremely high negative predictive value. Stress echocardiography is a better discriminator than clinical and rest echocardiographic variables.
接受大血管手术的患者发生心脏事件的风险相对较高，药物负荷超声心动图越来越多地用于围手术期风险分层。
在六个不同中心，对121例接受血管手术的患者（年龄65±7岁）进行了双嘧达莫超声心动图检查。在总共136例患者中，有15例随后被排除，原因是手术取消（n = 8）或因出现“高风险”负荷回声反应（“先验”定义为双嘧达莫超声心动图检查阳性，双嘧达莫给药时间<5分钟和/或峰值壁运动评分指数>2，在11节段模型中对每个节段从1 =正常到4 =运动障碍进行评分）而等待心脏血运重建（n = 7）。
双嘧达莫超声心动图检查期间未发生重大并发症。所有患者均获得了技术上足够的图像；然而，仅对一名患者给予了低剂量双嘧达莫（4分钟内56mg.kg-1）以限制副作用。在121例接受手术的患者中，28例（23%）检查结果为阳性。围手术期发生事件的有9例患者（8%）：2例死亡，2例心肌梗死，5例不稳定型心绞痛。双嘧达莫超声心动图检查预测心脏事件的敏感性和特异性分别为78%和81%，阳性预测值为25%，阴性预测值为98%。双嘧达莫超声心动图检查有效地将发生事件的患者与未发生事件的患者区分开来，但无论是临床参数（如德茨基评分）还是基线超声心动图参数（如静息壁运动评分指数或射血分数）都无法区分这些患者。
总之，双嘧达莫超声心动图检查在接受大血管手术的患者中是安全且耐受性良好的，并且主要由于极高的阴性预测值，为这些患者的风险分层提供了一种有效的术前筛查试验。负荷超声心动图比临床和静息超声心动图变量具有更好的鉴别能力。
