Prevalence and pharmacological treatment of left-ventricular dysfunction in patients undergoing vascular surgery.
OBJECTIVE
This study evaluated the prevalence of left-ventricular (LV) dysfunction in vascular surgery patients and pharmacological treatment, according ESC guidelines.


RESULTS
Echocardiography was performed pre-operatively in 1,005 consecutive patients. Left ventricular ejection fraction (LVEF) <or=50% defined systolic LV dysfunction. Diastolic LV dysfunction was diagnosed based on E/A-ratio, pulmonary vein flow, and deceleration time. Optimal pharmacological treatment to improve LV function was considered as: (i) angiotensin-blocking agent (ACE-I/ARB) in patients with LVEF <or=40%; (ii) ACE-I/ARB and beta-blocker in patients with LVEF <or=40% + heart failure symptoms or previous myocardial infarction; and (iii) a diuretic in patients with symptomatic heart failure, regardless of LVEF. Left-ventricular dysfunction was present in 506 patients (50%), of whom 209 (41%) had asymptomatic diastolic LV dysfunction, 194 (39%) had asymptomatic systolic LV dysfunction, and 103 (20%) had symptomatic heart failure. Treatment with ACE-I/ARB and/or beta-blocker could be initiated/improved in 67 (34%) of the 199 patients with (a)symptomatic LVEF <or=40%. A diuretic could be initiated in 32 patients (31%) with symptomatic heart failure (regardless of LVEF).


CONCLUSIONS
This study demonstrates a high prevalence of LV dysfunction in vascular surgery patients and under-utilization of ESC recommended pharmacological treatment. Standard pre-operative evaluation of LV function could be argued based on our results to reduce this observed care gap.
Flu
Willem-Jan
WJ
Department of Anesthesia, Erasmus Medical Center, Rotterdam, The Netherlands.
van Kuijk
Jan-Peter
JP
Galal
Wael
W
Kuiper
Ruud
R
van de Ven
Louis L
LL
Verhagen
Hence J M
HJ
Bax
Jeroen J
JJ
Poldermans
Don
D
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000704:Analysis of Variance; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D016001:Confidence Intervals; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011300:Preoperative Care; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D013318:Stroke Volume; D011795:Surveys and Questionnaires; D014656:Vascular Surgical Procedures; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology*; D016277:Ventricular Function, Left
D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents