Rossi E, Citterio F, Vescio M F, Pennestri F, Lombardo A, Loperfido F, Maseri A
Institute of Cardiology, Catholic University, Rome, Italy.
Am J Cardiol. 1998 Aug 1;82(3):306-10. doi: 10.1016/s0002-9149(98)00341-5.
Patients with advanced peripheral vascular disease have an increased cardiac morbidity and mortality. The aim of this study was to assess the predictive value of rest and stress echocardiography for perioperative and late cardiac events in 110 patients undergoing limb revascularization. All patients underwent preoperative clinical and echocardiographic evaluation at rest and by dipyridamole stress testing to assess cardiac risk. Patients with > or =3 clinical Eagle markers, low left ventricular ejection fraction at rest, or positive dipyridamole stress test results were considered at high cardiac risk. To record adverse cardiac events, all patients were monitored during and after surgery, and followed for at least 1 year after hospital discharge. Cardiac complications occurred in 10 patients (9.7%) perioperatively (2 fatal myocardial infarctions), and in 13 (13%) at 1-year follow-up (7 fatal myocardial infarctions). Echocardiographic evaluation was the best predictor of early (p <0.00003) and late (p <0.0003) cardiac complications. No patient with a negative dipyridamole stress test result and good left ventricular ejection fraction had cardiac complications, either postoperatively or during follow-up. Clinical evaluation does not appear sufficiently sensitive for predicting perioperative cardiac events, but was valuable in predicting late cardiac complications (p <0.0002). Our data show that echocardiographic evaluation of resting dysfunction and of the ischemic response to dipyridamole is a good predictor of perioperative cardiac risk, and is superior to generally available clinical data. Echocardiographic evaluation is useful in defining a low-risk group of patients who can safely undergo limb revascularization, whichever surgical procedure is proposed.
晚期外周血管疾病患者的心脏发病率和死亡率均有所增加。本研究旨在评估静息和负荷超声心动图对110例接受肢体血运重建患者围手术期及晚期心脏事件的预测价值。所有患者均接受术前临床及静息超声心动图评估，并通过双嘧达莫负荷试验评估心脏风险。具有≥3个临床Eagle标志物、静息时左心室射血分数低或双嘧达莫负荷试验结果为阳性的患者被视为心脏高危患者。为记录不良心脏事件，所有患者在手术期间及术后均接受监测，并在出院后随访至少1年。围手术期有10例患者（9.7%）发生心脏并发症（2例致命性心肌梗死），1年随访时有13例（13%）发生（7例致命性心肌梗死）。超声心动图评估是早期（p<0.00003）和晚期（p<0.0003）心脏并发症的最佳预测指标。双嘧达莫负荷试验结果为阴性且左心室射血分数良好的患者在术后或随访期间均未发生心脏并发症。临床评估对预测围手术期心脏事件似乎不够敏感，但对预测晚期心脏并发症有价值（p<0.0002）。我们的数据表明，对静息功能障碍及双嘧达莫缺血反应的超声心动图评估是围手术期心脏风险的良好预测指标，且优于一般可用的临床数据。无论采用何种手术方式，超声心动图评估有助于确定可安全接受肢体血运重建的低风险患者组。
