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Predictive Role of Stress Echocardiography before Carotid Endarterectomy in Patients with Coronary Artery Disease
Author(s) -
Galyfos George,
Tsioufis Constantinos,
Theodorou Dimitris,
Katsaragakis Stilianos,
Zografos Georgios,
Filis Konstantinos
Publication year - 2015
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12826
Subject(s) - medicine , cardiology , myocardial infarction , asymptomatic , stress echocardiography , carotid endarterectomy , cardiac surgery , coronary artery disease , troponin , troponin i , stenosis
Objectives Our aim was to examine the predictive value of preoperative stress echocardiography regarding early myocardial ischemia and late cardiac events after carotid endarterectomy ( CEA ). Methods Patients with coronary artery disease undergoing CEA were prospectively included in this study. All patients (n = 162) were classified into low, medium, and high cardiac risk group, according to preoperative stress echocardiography. Classification was based on the criteria of the American Society of Echocardiography. For all patients, cTnI was measured before surgery and on postoperative days 1, 3, and 7. Postoperative cTnI values ranging from 0.05 to 0.5 ng/mL were classified as myocardial ischemia; values >0.5 ng/mL were classified as myocardial infarction. Cardiac damage was defined as either myocardial ischemia or infarction. Results No deaths, strokes, or symptomatic coronary events were observed during the early postoperative period. There were 112 low cardiac risk patients, 42 medium‐risk patients, and 8 high‐risk patients, according to stress echocardiography findings. Overall, there were 22 patients (14%) that increased their cTnI values postoperatively (12 of low cardiac risk and 10 of medium cardiac risk), and all of them were asymptomatic. None of the high‐risk patients showed any troponin increase. Late cardiac events were associated with cTnI increase, although no high‐risk patients showed any late event. Conclusions Preoperative stress echocardiography does not seem to independently recognize patients in high risk for asymptomatic cardiac damage after CEA . Postoperative troponin elevation seems to be more predictive for late adverse cardiac events than preoperative stress echocardiography.