Value of Pharmacologic Stress Myocardial Perfusion Imaging for Preoperative Risk Stratification for Aortic Surgery

Abstract

valuating the risk of perioperative cardiac events related to noncardiac surgery is important. [1][2][3][4][5][6][7][8][9] Preoperative myocardial perfusion imaging is useful for further stratification of the risk in moderate-and highrisk patients 3,4 because the redistribution findings can be used as predictive factors for cardiac events, and the technique has a high negative predictive value. [5][6][7][8] Moreover, recent studies suggest that the likelihood of cardiac events increases with the severity of the defect score on images evaluated semi-quantitatively 4,6-9 and guidelines for the perioperative cardiovascular evaluation of noncardiac surgery patients were recently published by the ACC/AHA, providing a framework for weighting the cardiac risk of noncardiac surgery based on patients' risk profiles and the type of operation. 10 Of the procedures, aortic surgery is claimed to be high-risk (the reported cardiac risk is often ≥5%), not only because it is highly invasiveness surgery but also because of the high prevalence of coronary artery disease in patients with aortic diseases. 10-12 However, there are few studies regarding preoperative risk stratification in Japanese patients who undergo aortic surgery. 13,14 Thus, the present study evaluated whether perioperative cardiac events related to aortic surgery can be predicted by preoperative pharmacologic stress myocardial perfusion imaging. Methods SubjectsThe subjects of this study were 302 consecutive patients who underwent elective aortic surgery after pharmacologic stress single-photon emission computed tomography (SPECT) between January 1998 and August 2003. SPECT study was performed in all patients unless contraindications such as bronchial asthma and advanced heart block were present. There were 261 men and 41 women, aged 71±10 years (35-86 years); 128 of them (42%) were aged 75 years or older. Medical history of angina pectoris was noted in 19 patients, myocardial infarction (MI) in 26, and heart failure in 5; 19 of them had undergone coronary revascularization. Hypertension was found in 217 patients, hypercholesterolemia in 73, diabetes mellitus (DM) in 55, and renal insufficiency defined as serum creatinine level ≥2.0 mg/dl in 20.The etiologies of the aortic diseases were type B aortic dissection in 56 patients, thoracic aortic aneurysm in 124, and abdominal aortic aneurysm in 122. The indication for aortic surgery was decided by cardiovascular surgeons based on the anatomical and pathological indications. [15][16][17][18] The type of surgery was conventional open surgery in 75 patients and endovascular surgery with stent -graft placement in 227. Aortic surgery including stent -graft placement was performed under general anesthesia. Approval to perform the endovascular surgery was obtained from the Ethical Committee of Tokyo Medical University. Written informed consent was obtained from all of the patients. Stress Myocardial ScintigraphyPharmacologic stress SPECT was performed ≥15 h after Background Aortic surgery is an invasive, high-risk noncard...

2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

“…There are no reports of the use of percutaneous mitral balloon commissurotomy before noncardiac surgery; however, this procedure has excellent outcomes when used during high-risk pregnancies. 86 Left-sided regurgitant lesions convey increased cardiac risk during noncardiac surgery but are better tolerated than stenotic valvular disease. 88,89 AR and MR are associated with LV volume overload.…”

Comparison of Post-Exercise and Post-Vasodilator Stress Myocardial Stunning as Assessed by Electrocardiogram-Gated Single-Photon Emission Computed Tomography

“…SPECT images were reconstructed from the data using a data Odyssey VP processor (Picker) combined with a Butterworth filter (order 8; cutoff frequency 0.25) and a ramp filter. 14 …”

Safety of and Tolerance to Adenosine Infusion for Myocardial Perfusion Single-Photon Emission Computed Tomography in a Japanese Population

“…1 Dipyridamole in conjunction with thallium imaging has been widely used as an alternative to exercise for patients unable to perform adequate exercise stress testing. 2,3 However, side-effects caused by dipyridamole administration are frequent and can be life-threatening, because of its prolonged pharmacologic effect (15-30 min when administered intravenously), and it is often necessary to eliminate side-effects with intravenous aminophylline infusion.…”