CHICAGO (May 24, 2010) –Symptomatic heart failure prior to surgery
is routinely acknowledged as a risk factor for adverse outcomes for
both cardiac and non-cardiac surgeries. In a new study published in the
June Anesthesiology, researchers delve further into the
implications of cardiac problems on postoperative outcomes, exploring
preoperative diagnosis and impact of asymptomatic left ventricular (LV)
dysfunction in vascular surgery patients.
dysfunction is considered a precursor to symptomatic heart failure, a
condition researchers from the Department of Anesthesiology at Erasmus
Medical Center in Rotterdam, The Netherlands, recognize as a well
established risk factor for postoperative cardiac events.
“We conducted the present study to evaluate
the impact of asymptomatic systolic and/or diastolic LV dysfunction on
outcomes following surgery,” said study investigator Don Poldermans,
M.D., Ph.D. of the Department of Anesthesiology at Erasmus Medical
Center. “LV dysfunction is frequently present, and mostly asymptomatic.
If it is proven that asymptomatic dysfunction is involved in adverse
cardiac outcomes, proper perioperative care and therapy can be
initiated to prevent worsening of heart failure during surgery.”
About the Study
LV dysfunction was
diagnosed through echocardiography performed preoperatively on 1,005
consecutive vascular surgery patients. LV dysfunction was diagnosed in
506 of the patients evaluated. Of these diagnosed patients, 80 percent
of the cases were asymptomatic.
diagnoses were evaluated to be either systolic and/or diastolic LV
dysfunction. If LV dysfunction was present in combination with heart
failure symptoms of shortness of breath, fatigue, exercise intolerance
or signs of fluid retention, patients were diagnosed with symptomatic
underwent open vascular surgery or minimally invasive endovascular
surgery and were evaluated for cardiovascular events for 30 days
following surgery and for long-term cardiovascular related death.
Cardiovascular events included myocardial ischemia, myocardial
infarction, and cardiovascular event-related death.
Outcomes and Next Steps
In open vascular
surgery, both asymptomatic systolic and isolated diastolic LV
dysfunction was associated with cardiovascular events occurring within
30 days following surgery and long-term cardiovascular-related death.
For patients treated through endovascular surgery, only patients
diagnosed with symptomatic heart failure before surgery were associated
with 30-day cardiovascular events and long-term cardiovascular related
established the need to evaluate all possible cardiovascular risk
factors for high-risk vascular surgery patients.
“This study demonstrated that asymptomatic
LV dysfunction is indeed predictive for adverse 30-day and long-term
cardiovascular outcomes in open vascular surgery patients,” said Dr.
Poldermans. “The data suggest that routine assessment for asymptomatic
left ventricular dysfunction prior to vascular surgery improves
preoperative risk stratification.”
Dr. Poldermans and
colleagues conclude that perioperative care therapy such as
beta-blockers can be an effective treatment to improve postoperative
outcomes. Dr. Poldermans recommends that if asymptomatic heart failure
is present and beta-blocker therapy is considered, a carefully titrated
dosing regimen be implemented in these patients.
editorial by Leanne Groban, M.D. and Dalane W. Kitzman, M.D., of the
Departments of Anesthesiology and Internal Medicine, Section on
Cardiology, Sticht Center of Aging, Wake Forest School of Medicine in
Winston-Salem, North Carolina, discusses clinical implications of the
study results, predicting that preclinical detection of LV
dysfunction will improve risk estimates and enable for better
management of therapy around the time of surgery to decrease the
occurrence of cardiovascular events. The authors summarized that
therapy strategies could include optimization of preoperative cardiac
medications, enhanced monitoring, specialized fluid management
strategies or more intensive postoperative surveillance.