This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Thompson, C. Articles by Parlow, J. L. Search for Related Content PubMed PubMed Citation Articles by Thompson, C. Articles by Parlow, J. L.

Limitations of preoperative dobutamine stress echocardiography in identifying severe left main coronary artery stenosis: a report of two cases and a brief review

[Les limites de l’échocardiographie d’effort préopératoire avec dobutamine dans l’identification d’une sténose du tronc de l’artère coronaire gauche : observation de deux cas et brève revue]

From the Department of Anesthesiology, Queen’s University, Kingston, Ontario, Canada.

Address correspondence to: Dr. Joel L. Parlow, Department of Anesthesiology, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada. Phone: 613-548-7827; Fax: 613-548-1375; E-mail: parlowj{at}post.queensu.ca

Purpose: Using case illustrations, to elucidate factors which increase the likelihood of false negative preoperative dobutamine stress echocardiography (DSE) studies in patients with severe left main coronary artery stenosis, and to provide criteria which must be met in order to ensure the accurate interpretation of these tests.

Clinical features and source: Two patients presented for elective abdominal aortic aneurysm repair within a one-month period of time. Both patients had DSE as part of their preoperative assessment, which were interpreted as normal. Nevertheless, both suffered major coronary events in the perioperative period, and both proved to have severe left main coronary artery stenosis on postoperative angiography. A narrative review is presented based on a selection of the current literature, and local experience with the technique. Some pitfalls in the interpretation of these tests are presented, along with modalities to increase their sensitivity and specificity.

Conclusion: DSE is an important and useful modality in the preoperative cardiac evaluation of patients who are unable to exercise. However the reliable interpretation of the test depends on an understanding of the limitations of the procedure.

This article has been cited by other articles:

				M.-C. Parent and S. Rinfret The unresolved issues with risk stratification and management of patients with coronary artery disease undergoing major vascular surgery: [Questions non resolues concernant la stratification du risque et la prise en charge des patients atteints de maladie coronarienne subissant une chirurgie vasculaire majeure] Can J Anesth, August 1, 2008; 55(8): 542 - 556. [Abstract] [Full Text] [PDF]