title: The role of preoperative radionuclide left ventricular ejection fraction for risk assessment in carotid surgery.
abstract: Radionuclide ejection fraction (EF) and ventricular wall motion were determined in 73 patients before 82 carotid operations (79 carotid endarterectomies [CEAs] and three cervical carotid-subclavian bypasses). The EF was 55% +/- 13%, ranging from 21% to 77%. Thirty-three percent (24/73) had low EF (less than or equal to 50%), and 44% (28/63) had myocardial wall motion abnormalities. Perioperative cardiac complications, including myocardial infarction (MI), new ventricular arrhythmia, or severe congestive heart failure, were present after 12.2% (10/82) of the operations. Perioperative MI was present in 4.9% (4/82); in 50% of these it was fatal. Perioperative (30-day) stroke was present in 2.5% (2/79) of those undergoing CEA. Life table analysis revealed overall survival was lower in patients with EF of 35% or less vs those with EF over 35% during follow-up (522 +/- 280 days). Perioperative cardiac complications were more frequent with EF of 35% or less, occurring in 43% (3/7) vs 9% (7/75) of cases with EF over 35%. There was no statistical difference in perioperative mortality, but cumulative mortality differed, being 57% (4/7) in those with EF of 35% or less vs 11% (7/66) in patients with EF over 35%. Patients with EF of 35% or less are at increased risk for perioperative cardiac complications and reduced overall survival following carotid surgery.
authors.affiliation: Department of Surgery, Seattle Veterans Administration Medical Center, WA 98108.
authors.forename: A
authors.initials: A
authors.lastname: Kazmers
authors.forename: M D
authors.initials: MD
authors.lastname: Cerqueira
authors.forename: R E
authors.initials: RE
authors.lastname: Zierler
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D004691:Endarterectomy / Q000009:adverse effects* / Q000401:mortality; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D009200:Myocardial Contraction; D011300:Preoperative Care; D011877:Radionuclide Imaging; D012307:Risk Factors; D013318:Stroke Volume