Prognostic implications of asymptomatic left ventricular dysfunction in patients undergoing vascular surgery.
BACKGROUND
The prognostic value of heart failure symptoms on postoperative outcome is well acknowledged in perioperative guidelines. The prognostic value of asymptomatic left ventricular (LV) dysfunction remains unknown. This study evaluated the prognostic implications of asymptomatic LV dysfunction in vascular surgery patients assessed with routine echocardiography.


METHODS
Echocardiography was performed preoperatively in 1,005 consecutive vascular surgery patients. Systolic LV dysfunction was defined as LV ejection fraction less than 50%. Ratio of mitral-peak velocity during early and late filling, pulmonary vein flow, and deceleration time was used to diagnose diastolic LV dysfunction. Troponin-T measurements and electrocardiograms were performed routinely perioperatively. Multivariate regression analyses evaluated the relation between LV function and the study endpoints, 30-day cardiovascular events, and long-term cardiovascular mortality.


RESULTS
Left ventricular dysfunction was diagnosed in 506 (50%) patients of which 80% were asymptomatic. In open vascular surgery (n = 649), both asymptomatic systolic and isolated diastolic LV dysfunctions were associated with 30-day cardiovascular events (odds ratios 2.3, 95% confidence interval [CI] 1.4-3.6 and 1.8, 95% CI 1.1-2.9, respectively) and long-term cardiovascular mortality (hazard ratios 4.6, 95% CI 2.4-8.5 and 3.0, 95% CI 1.5-6.0, respectively). In endovascular surgery (n = 356), only symptomatic heart failure was associated with 30-day cardiovascular events (odds ratio 1.8, 95% CI 1.1-2.9) and long-term cardiovascular mortality (hazard ratio 10.3, 95% CI 5.4-19.3).


CONCLUSIONS
This study demonstrated that asymptomatic LV dysfunction is predictive for 30-day and long-term cardiovascular outcome in open vascular surgery patients. These data suggest that preoperative risk stratification should include not only solely heart failure symptoms but also routine preoperative echocardiography to risk stratify open vascular surgery patients.
Flu
Willem-Jan
WJ
Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands.
van Kuijk
Jan-Peter
JP
Hoeks
Sanne E
SE
Kuiper
Ruud
R
Schouten
Olaf
O
Goei
Dustin
D
Elhendy
Abdou
A
Verhagen
Hence J M
HJ
Thomson
Ian R
IR
Bax
Jeroen J
JJ
Fleisher
Lee A
LA
Poldermans
Don
D
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D020107:Troponin T / Q000097:blood; D014656:Vascular Surgical Procedures / Q000009:adverse effects*; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging*
D020107:Troponin T