非心脏手术行极量与次极量多巴酚丁胺负荷超声心动图试验阴性患者的心脏事件:静息室壁运动异常的意义

作     者：Labib S.B. Goldstein M. Kinnunen P.M. Schick E.C. 苏显明 

作者机构：Dept. of Ca rdiovascular Medicine Lahey Clinic Burlington MA United StatesDr. 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2005年第1卷第1期

页      面：40-41页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：负荷超声心动图 室壁运动异常 多巴酚丁胺 心脏事件 非心脏手术 阴性患者 预测价值 心肌缺血患者 β受体阻滞剂 次极 

摘      要：Objectives This study sought to evaluate the negative predictive value( NPV) of preoperative dobutamine stress echocardiography(DSE) in patients who fail to ac hieve target heart rate(HR) and assess the influence of resting wall motion abno rmalities(WMAs) without demonstrable ischemia on perioperative events. Backgroun d The prognostic value of a negative-submaximal DSE study before noncardiac sur gery is unknown. Methods Consecutive patients (n=429) who underwent surgery over a three-year period, preceded by DSE, were included. We compared perioperative event rates among those without inducible ischemia according to whether or not 85%age-adjusted maximum HR was achieved, and whether WMAs were present at rest . Results Of 397 negative DSEs, peak HR was vs. 7 of 397 ; p =0.03) , but with similar frequency among the negative-maximal and negative-su bmaximal groups(6 of 335, 1.8%vs. 1 of 62, 1.6%, respectively). Accordingly, t he NPV was 98%in both subgroups. Events occurred exclusively in patients with W MAs at rest: 7 of 100 (7%) versus 0 of 297 (0%) (p 0.0001). Conclusions In p atients undergoing preoperative DSE, failure to achieve target HR is not uncommo n despite an aggressive DSE regimen. A negative DSE without resting WMAs has exc ellent NPV regardless of the HR achieved. Patients with resting WMAs appear to b e at increased risk for perioperative events even without provokable ischemia.