Use of stress thallium imaging to stratify cardiac risk in patients undergoing vascular surgery. J Surg Res 1992 Feb;52(2):147-51 PMID: 1740936
Abstract
Reduction of the cardiac morbidity associated with major vascular procedures requires identification of high risk patients prior to operation. This retrospective study reviews the records of 126 consecutive patients who underwent 141 major vascular procedures to determine the accuracy of preoperative clinical, laboratory (ECG), and cardiac function testing (stress thallium-201 scintigraphy, left ventricular ejection fraction scan) in predicting perioperative cardiac complications. An abnormality on oral dipyridamole or treadmill thallium imaging was demonstrated prior to 71 (61%) of 116 procedures and included 20 fixed and 51 reperfusion (reversible) defects. No patient died within 30 days of operation, but 11 minor (ventricular arrhythmia) and 15 major (myocardial infarction, ischemic congestive heart failure) cardiac complications occurred. A reperfusion defect on stress thallium imaging accurately (94% sensitivity, 56% specificity, 98% negative predictive value) identified high-risk patients while accepted clinical rating systems (Goldman, Cooperman, Eagle) and preoperative level of left ventricular ejection fraction were less predictive of adverse cardiac events. Patients without myocardium at risk by coronary angiography, but a reperfusion defect on stress thallium imaging were found to be at high risk for a cardiac complication. The study data support the use of stress thallium imaging to stratify cardiac risk prior to major arterial surgery.
Author List
Reifsnyder T, Bandyk DF, Lanza D, Seabrook GR, Towne JBAuthor
Gary R. Seabrook MD Chief, Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Aged, 80 and over
Exercise Test
Heart
Heart Diseases
Humans
Male
Middle Aged
Radionuclide Imaging
Retrospective Studies
Risk Factors
Stroke Volume
Thallium Radioisotopes
Vascular Surgical Procedures
View this publication's entry at the Pubmed website PMID: 1740936
