[Evaluation of cardiac risk before vascular surgery by dobutamine stress echocardiography].

The detection of coronary artery disease is essential before abdominal aortic surgery. In view of the limitations of the usual methods of investigation, dobutamine stress echocardiography was assessed in this indication. Eighty-five patients with an aortic abdominal aneurysm or obstructive arterial disease underwent dobutamine stress echocardiography followed by coronary angiography. Depending on the results, vascular surgery was performed directly, after myocardial revascularisation or not at all. Significant coronary lesions (stenosis > or = 50%) were found in 32 of the 85 patients (38%). Dobutamine stress echocardiography had a sensitivity of 78% and a specificity of 75%, and positive and negative predictive values of 66 and 85% respectively. The relative risk of coronary disease was 4.4. In this series, 15 patients had severe coronary lesions: 2 were turned down for surgery and 13 underwent myocardial revascularisation; 14 of them (93%) had a positive stress echo. The only 2 non-fatal cardiac complications of peripheral surgery (3%) occurred after a positive dobutamine stress echo. This study confirms both the necessity of preoperative assessment of coronary risk and the efficacy of dobutamine stress echocardiography in this indication. Dobutamine stress echocardiography is reliable, non-invasive, economical and a real alternative to isotopic methods. Its good predictive value justifies using coronary angiography only for patients with a positive result.