Author + information
- Received May 21, 1990
- Revision received October 16, 1990
- Accepted January 23, 1991
- Published online July 1, 1991.
- Thomas A. Watters, MD1,2,
- Elias H. Botvinick, MD, FACC*,1,
- Michael W. Dae, MD1,
- Michael Cahalan, MD1,
- John Urbanowicz, MD1,
- David J. Benefiel, MD1,
- Nelson B. Schiller, MD, FACC1,
- Gerald Goldstone, MD1,
- Linda Reilly, MD1 and
- Ronald J. Stoney, MD1
- ↵*Address for reprints: Elias H. Botvinick, MD, Cardiovascular Division, Box 0252, Room 1186M, University of California Medical Center, San Francisco, California 94143.
The evidence of myocardium at potential ischemic risk on preoperative dipyridamole perfusion scintigraphy was compared with that of manifest ischemia on intraoperative transesophageal echocardiography in 26 patients at high risk of a coronary event undergoing noncardiac surgery. The clinical outcome was also assessed. Induced intraoperative wall motion abnormalities were more common in patients and myocardial segments with, than in those without, a preoperative reversible perfusion defect (both p < 0.05). Conversely, a preoperative reversible perfusion defect was more common in patients and segments with, than in those without, a new intraoperative wall motion abnormality (both p < 0.05).
Six patients, five with a reversible scintigraphic defect but only three with a new wall motion abnormality, had a hard perioperative ischemic event. Events occurred more often among patients with, than in those without, a reversible perioperative scintigraphic defect (5 [33%] of 15 vs. 1 [9%] of 11) but this difference did not reach significance (p = 0.14), probably owing to the sample size. Intraoperative wall motion abnormalities were all reversible and did not differentiate between risk groups; these findings were possibly influenced by treatment.
These preliminary data support the known relation between reversible scintigraphic defects and perioperative events and identify another manifestation of ischemic risk in the relation between reversible scintigraphic defects and induced intraoperative wall motion abnormalities. The value of intraoperative echocardiography in identifying ischemia and guiding therapy in patients with a reversible scintigraphic abnormality should be further assessed.
- Received May 21, 1990.
- Revision received October 16, 1990.
- Accepted January 23, 1991.
- American College of Cardiology Foundation