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Background: Because patients undergoing major noncardiac surgery are at risk for adverse cardiovascular events, it is recommended to do thorough perioperative assessments. However, echocardiography is recommended to evaluate the valve condition and the left ventricular (LV) systolic function when patients have heart failure symptoms or dyspnea on unknown cause. Nevertheless, it is shown that those patients having asymptomatic LV systolic dysfunction have high the major cardiovascular event (MACE) rate. The role of echocardiography study for preoperative risk evaluation is not well-illustrated. Therefore, we conducted this prospective study to investigate prognostic value of preoperative echocardiographic study for patients scheduled to undergo noncardiac surgery.
Methods: From February 2013 to June 2016, we enrolled 2,280 patients (male 45.1%, age 69.2±15.3 years) undergoing scheduled noncardiac surgery in 2 university hospitals in Tainan, Taiwan. They all received pre-operative echocardiography. All the patients were followed-up for 56 days after surgery. The primary outcome was major adverse events (MAEs), defined as all-cause mortality and MACEs, i.e. cardiovascular death, cardiac hospitalization, and stroke. Multivariate Cox regression analysis was used to investigate risk factors for MAEs and MACEs.
Results: Forty-one patients (1.8%) reached primary outcome. Using multi-variate Cox regression analyses, increased left atrial volume (LAV) index (p < 0.001) and LV end-diastolic volume (EDV) index (p = 0.049) were independent predictors of MAEs. The predictors of MACEs were atrial fibrillation and severe mitral regurgitation.
Conclusions: Preoperative echocardiographic study could identify the high risk patients of peri-operative cardiovascular events. LAV index and LVEDV index provided prognostic information beyond standard risk factors for scheduled noncardiac surgery patients.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Innovations in Cardiovascular Risk Assessment and Reduction
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1235-064
- 2017 American College of Cardiology Foundation