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Vol 10, No 3-4 (2008)
Published online: 2009-05-06

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Echocardiographic dobutamine stress test in patients with chronic stable angina qualified for vascular reconstructive procedures

Teresa Kowalewska-Twardela, Krzysztof Ziaja, Tomasz Urbanek, Bartosz Wnuk, Damian Ziaja, Wacław Kuczmik, Dariusz Stańczyk, Grzegorz Biolik, Tomasz Gul, Anna Janowska, Łukasz Rodak
Chirurgia Polska 2008;10(3-4):133-140.

Abstract

Background: The echocardiographic dobutamine stress test (EDST) is one of the most commonly used pharmacological stress tests in the diagnostics of coronary heart disease. In this paper the usefulness of EDST in the preoperative evaluation in patients with chronic stable angina qualified for vascular reconstructive procedures was evaluated.
Materials and methods: The study group consisted of 60 patients hospitalized because of abdominal aortic aneurysm (AAA) in the years 2006–2007. There were 59 males and 1 female, aged 63.5 ± 8 years. All of these patients underwent a dobutamine stress test. The patients were divided into 3 groups according to the results of the test: a negative stress test group comprising 38 patients (63.3%), a positive stress test group comprising 15 patients (25%), as well as a slightly positive stress test group comprising 7 patients (11.7%). Regarding the aim of study, the following coronary heart disease risk factors and coexisting diseases were considered: hypertension, past myocardial infarction, diabetes mellitus, gout, atherosclerosis of the arteries of the lower extremities, carotid artery stenosis, past cerebral infarction, and cigarette smoking. The frequency of coexisting diseases between the groups displaying negative dobutamine stress test (-) and positive dobutamine stress test (+) results was compared.
Results: Those patients with a negative EDST were immediately referred for AAA surgery, more specifically 92.1% (n = 35) to undergo open repair and 7.9% (n =3) to undergo endovascular treatment. Those patients with a positive EDST were qualified for coronarography and invasive coronary heart disease treatment at the first stage, among them 86.6% (n = 13) to undergo PTCA and 13.4% (n = 2) to undergo CABG. At the next stage they underwent AAA reconstruction, more specifically 66.6% (n = 10) open repair and 33.4% (n = 5) endovascular treatment. In the group of patients with negative EDST test, one non-cardiological death was reported (pulmonary embolia) on the third postoperative day after open AAA surgery. Those patients with a positive EDST had a significantly higher frequency of diabetes mellitus, carotid artery stenosis and peripheral artery stenosis coexisting with carotid artery stenosis. These patients smoked cigarettes significantly less often, which was the result of their greater awareness due to previous treatment (PTCA, CABG etc.).
Conclusions: Results of our study showed that a preoperative dobutamine stress test should be performed on patients with stable coronary heart disease along with coexisting diabetes mellitus, atherosclerosis of the arteries of the lower extremities, or carotid artery stenosis.

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Chirurgia Polska (Polish Surgery)