Autonomic/Electrophysiology

This study was undertaken to determine the prognostic significance of hypotension induced during preoperative dobutamine echoeardiography (DSE) prior to vascular and non-cardiac thoracic surgery. motion abnormalities (WMA) during DSE predict pcriopcrativc risk. Although hypotension during DSE does not correlate with the presence or severity of coronary artcry disease, its significance in periopcrative risk assessment is unknown. We retrospectively studied 300 patients who had DSEwithin 6 months of noncardiac surgery. Perioperative events. including death, myocardial infarction, ischemia, and arrhythmias were recorded. Odds ratios (OR) with 95% Cl's were used to examine the association between clinical and eehoeardiographie variablesand pcriopcrative events. A hypotensive response during DSEwas seen in85 patients (28%). Forty eight patients (16%) had 54 perioperative complications including 4 cardiac related deaths, 10 myocardial infarctions, 12myocardial ischemicevents and 28 arrhythmias. Hypolension during DSEwaspredictive ofthe combined end point of periopcrative cardiac mortality. myocardial infarction and ischemia (OR 4. 04, 95% CI 1. 72 - 9. 51). In a multivariate logistic regression model, hypotension during DSE remaineda significant predictor (OR 4. 10, 1'<0. 01). DSErelated hypotension Was predictive ofperioperative cardiac events and therefore may have a role in risk stratification prior to vascular or non-cardiac thoracic surgery.