Stress echocardiography with regadenoson for the assessment of perioperative cardiovascular risk in non-cardiac surgery

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The most commonly used drug in pharmacological stress echocardiography (SE) for perioperative cardiovascular (CV) risk assessment is dobutamine. Its arrhythmogenic potential and the unpredictable hypertensive response in patients with vascular pathology, makes us often resort to other less accessible and more expensive techniques such as Cardio-MRI or SPECT. Regadenoson is emerging as a safe drug in the detection of myocardial ischemia, although its use has not yet been validated in SE. Purpose The objective is to assess the short-medium term prognosis in patients undergoing high-risk noncardiac surgery who undergo SE with regadenoson. Methods A unicentric retrospective observational study. We included a subgroup of 58 patients referred for detection of ischemia prior to high-risk noncardiac surgery who underwent SE with regadenoson during the years 2017-2020. No patient has had cardiological symptoms. The test was considered positive if it presented at least one of the following: wall motion abnormalities, electrocardiographic and/or clinical changes compatible with ischemia. Patients were followed up in the immediate postoperative period (30 days), at 12 months and at 24 months, considering the presence of CV events such as admission for heart failure (HF), chest pain, acute myocardial infarction (AMI) or CV death. It was compared the group with negative (NG) and the group with positive (PG) results. Results 97% of the patients underwent vascular high-risk noncardiac surgery, 3% underwent other surgeries such as kidney transplantation or lung surgery considered high risk in the preanesthetic assessment. Twelve studies (21%) were positive and of these, only 2 patients underwent coronary artery bypass prior to surgery. The only CV event observed in this period was HF: in the NG 3 episodes were observed compared to 1 in the PG (p = 0.82), only in one of the events for HF was coronary angiography done that did not show coronary artery disease. The time to the NG event was a median of 90 [3-600] days versus 180 days in the PG. The cumulative incidence (CI) of events in the NG in the immediate postoperative period (30 days post-surgery) was 2%, annual 4% and biannual 7%. Conclusions A SE test with negative regadenoson prior to high-risk noncardiac surgery presents a low CI of events in the immediate postoperative period and in the short-medium term. Abstract Figure.