Authors: Mohamed Abdel Shafy Tabl, Ahmad Youssif Nammour.
Background: Before major non cardiac surgeries, non-invasive functional testing widely indicated for evaluating patients with reduced exercise capacity.
Aim: To assess the accuracy of dobutamine stress echocardiography (DSE) for risk stratification prior to major nonâ€cardiac surgeries.
Methods: Eighty patients hospitalized for major non-cardiac surgeries underwent DSE and were reviewed to determine major adverse cardiac events (MACE) up to 30 days postâ€discharge.
Results: Out of 80 DSE performed for preoperative risk stratification, 12.5% were positive and 87.5% were negative. Postoperative MACE in the DSE +ve group was 36% compared to 4% in the DSEâ€ve group (OR = 14.8889, p = 0.002). Based on the MACE rates, the overall sensitivity of DSE was 56%, specificity was 90%, and positive predictive value (PPV) was only 36% while negative predictive value (NPV) was 95%. The admission for ICU and total days of hospital stay post surgery was comparable in both groups (p = 0.177).
Conclusion: DSE for preoperative risk stratification had a high clinical utility in patients undergoing major nonâ€cardiac surgery. In particular, a normal DSE had a high negative predictive value for post-operative MACE up to 30 days post discharge. Positive DSE did not correlate with the admission for ICU or total days of hospital stay post major non cardiac surgery.
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