76
|
Winkel T, Schouten O, Voûte M, Hoeks S, Welten G, Bax J, Verhagen H, Poldermans D. The effect of statins on perioperative events in patients undergoing vascular surgery. Acta Chir Belg 2010; 110:28-31. [PMID: 20306905 DOI: 10.1080/00015458.2010.11680560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Despite recent advancements in perioperative care and guideline recommendations, patients undergoing vascular surgery remain at risk for perioperative cardiovascular complications. In this review, the results are summarized of the most recent studies on the effectiveness and safety of perioperative statin use for the prevention of these perioperative cardiovascular complications. Perioperative statin therapy was associated with an improvement in postoperative cardiovascular outcome and a reduction in serum lipid levels and levels of inflammation markers.
Collapse
|
77
|
Poldermans D, Bax JJ, Boersma E, Hert SD, Eeckhout E, Fowkes G, Gorenek B, Hennerici MG, Iung B, Kelm M, Kjeldsen KP, Kristensen SD, Lopez-Sendon J, Pelosi P, Philippe F, Pierard L, Ponikowski P, Schmid JP, Sellevold OF, Sicari R, Berghe GVD, Vermassen F, Evseev MO. GUIDELINES FOR PRE-OPERATIVE CARDIAC RISK ASSESSMENT AND PERIOPERATIVE CARDIAC MANAGEMENT IN NON-CARDIAC SURGERY. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2010. [DOI: 10.20996/1819-6446-2010-6-4-578-598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
78
|
van Kuijk JP, Flu WJ, Welten GMJM, Hoeks SE, Chonchol M, Vidakovic R, Verhagen HJM, Bax JJ, Poldermans D. Long-term prognosis of patients with peripheral arterial disease with or without polyvascular atherosclerotic disease. Eur Heart J 2009; 31:992-9. [DOI: 10.1093/eurheartj/ehp553] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
79
|
Smolderen KG, Hoeks SE, Pedersen SS, van Domburg RT, de Liefde II, Poldermans D. Lower-leg symptoms in peripheral arterial disease are associated with anxiety, depression, and anhedonia. Vasc Med 2009; 14:297-304. [PMID: 19808714 DOI: 10.1177/1358863x09104658] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with peripheral arterial disease (PAD) report diverse clinical manifestations that are not always consistent with classic intermittent claudication. We examined the degree to which atypical exertional leg symptoms, intermittent claudication, and exertional leg symptoms that begin at rest were associated with mood states such as anxiety, depressive symptoms, and anhedonia (i.e. lack of positive affect). A cohort of consecutive PAD patients (n = 628) from the Erasmus Medical Center, Rotterdam, The Netherlands, completed the Hospital Anxiety and Depression Scale and the San Diego Claudication questionnaire. The ankle-brachial index and clinical factors were assessed in all patients at baseline. Anxiety was present in 29%, depressive symptoms in 30%, and anhedonia in 28% of patients. Pain at rest was independently associated with anxiety, depressive symptoms, and anhedonia (ORs between 2.5 and 4.0, p </= 0.001), while there was no relationship between intermittent claudication and mood states. Patients with atypical leg symptoms had a twofold risk of anxiety (OR = 1.9, 95% CI 1.1-3.5, p < 0.05). Adjusting for sex, age, ankle-brachial index, cardiovascular history, time since ankle-brachial index screening, clinical factors, and medication use, both pain at rest (OR = 3.4, 95% CI 1.6-7.0, p = 0.001) and atypical leg symptoms (OR = 2.3, 95% CI 1.1-4.9, p < 0.05) were associated with comorbid mood problems. In conclusion, PAD patients with atypical leg symptoms or pain at rest reported more impaired mood than patients without those symptoms. These patients should be monitored closely in clinical practice, as previous research in cardiovascular patients has shown that mood disorders and sub-threshold symptoms predict poor prognosis.
Collapse
|
80
|
Winkel T, Schouten O, Hoeks S, Verhagen H, Bax J, Poldermans D. Prognosis of Transient New-Onset Atrial Fibrillation During Vascular Surgery. J Vasc Surg 2009. [DOI: 10.1016/j.jvs.2009.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
81
|
Schinkel AF, Elhendy A, van Domburg RT, Biagini E, Rizzello V, Veltman CE, ten Kate GL, Sijbrands EJ, Akkerhuis KM, Geleijnse ML, ten Cate FJ, Simoons ML, Bax JJ, Poldermans D. Prognostic significance of QRS duration in patients with suspected coronary artery disease referred for noninvasive evaluation of myocardial ischemia. Am J Cardiol 2009; 104:1490-3. [PMID: 19932780 DOI: 10.1016/j.amjcard.2009.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 07/08/2009] [Accepted: 07/08/2009] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to evaluate the prognostic significance of QRS duration in patients with suspected coronary artery disease (CAD) referred for noninvasive evaluation of myocardial ischemia by dobutamine stress echocardiography. QRS duration is a prognostic marker in patients with previous myocardial infarction and/or heart failure. The relation between QRS duration and outcome of patients without known heart disease has not been evaluated. A total of 1,227 patients (707 men, mean age 61 +/- 14 years) with suspected CAD underwent dobutamine stress echocardiography for evaluation of myocardial ischemia. Patients were followed to determine predictors of cardiac events and to assess the incremental significance of QRS duration compared to clinical and dobutamine stress echocardiographic data. During a mean follow-up of 4.2 +/- 2.4 years, 280 patients (23%) died (129 cardiac deaths), and 60 (5%) had a nonfatal infarction. Annualized cardiac death rates were 2.0% in patients with QRS duration <120 ms and 4.4% in patients with QRS duration >or=120 ms, respectively (p <0.0001). Annualized event rates for cardiac death/nonfatal infarction were 2.8% in patients with QRS duration <120 ms and 4.8% in patients with QRS duration >or=120 ms (p = 0.0001). Multivariate models identified age, male gender, smoking, QRS duration >or=120 ms, and an abnormal dobutamine stress echocardiogram as independent predictors of cardiac death and the combined end point cardiac death/nonfatal infarction. In conclusion, QRS duration is an independent predictor of cardiac death and cardiac death/nonfatal infarction in patients with suspected CAD. This risk is persistent after adjustment for clinical variables, left ventricular function, and myocardial ischemia.
Collapse
|
82
|
van Kuijk JP, Flu WJ, Schouten O, Hoeks SE, Schenkeveld L, de Jaegere PPT, Bax JJ, van Domburg RT, Serruys PW, Poldermans D. Timing of noncardiac surgery after coronary artery stenting with bare metal or drug-eluting stents. Am J Cardiol 2009; 104:1229-34. [PMID: 19840567 DOI: 10.1016/j.amjcard.2009.06.038] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 06/14/2009] [Accepted: 06/14/2009] [Indexed: 01/08/2023]
Abstract
The current guidelines have recommended postponing noncardiac surgery (NCS) for > or =6 weeks after bare metal stent (BMS) placement and for > or =1 year after drug-eluting stent (DES) placement. However, much debate has ensued about these intervals. The aim of the present study was to assess the influence of different intervals between stenting and NCS and the use of dual antiplatelet therapy on the occurrence of perioperative major adverse cardiac events (MACEs). We identified 550 patients (376 with a DES and 174 with a BMS) by cross-matching the Erasmus Medical Center percutaneous coronary intervention (PCI) database with the NCS database. The following intervals between PCI-BMS (<30 days, <3 months, and >3 months) or PCI-DES (<30 days, <3 months, 3 to 6 months, 6 to 12 months, and >12 months) and NCS were studied. MACEs included death, myocardial infarction, and repeated revascularization. In the PCI-BMS group, the rate of MACEs during the intervals of <30 days, 30 days to 3 months, and >3 months was 50%, 14%, and 4%, respectively (overall p <0.001). In the PCI-DES group, the rate of MACE changed significantly with the interval after PCI (35%, 13%, 15%, 6%, and 9% for patients undergoing NCS <30 days, 30 days to 3 months, 3 to 6 months, 6 to 12 months, and >12 months, respectively, overall p <0.001). Of the patients who experienced a MACE, 45% and 55% were receiving single and dual antiplatelet therapy at NCS, respectively (p = 0.92). The risk of severe bleeding in patients with single and dual therapy at NCS was 4% and 21%, respectively (p <0.001). In conclusion, we found an inverse relation between the interval from PCI to NCS and perioperative MACEs. Continuation of dual antiplatelet therapy until NCS did not provide complete protection against MACEs.
Collapse
|
83
|
Goei D, Flu WJ, Hoeks SE, Galal W, Dunkelgrun M, Boersma E, Kuijper R, van Kuijk JP, Winkel TA, Schouten O, Bax JJ, Poldermans D. The Interrelationship Between Preoperative Anemia and N-Terminal Pro-B-Type Natriuretic Peptide: The Effect on Predicting Postoperative Cardiac Outcome in Vascular Surgery Patients. Anesth Analg 2009; 109:1403-8. [DOI: 10.1213/ane.0b013e3181b893dd] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
84
|
Poldermans D, Devereaux PJ. The experts debate: Perioperative beta-blockade for noncardiac surgery—proven safe or not? Cleve Clin J Med 2009; 76 Suppl 4:S84-92. [DOI: 10.3949/ccjm.76.s4.14] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
85
|
van Kuijk J, Schouten O, Flu W, den Uil C, Bax J, Poldermans D. Perioperative Blood Glucose Monitoring and Control in Major Vascular Surgery Patients. J Vasc Surg 2009. [DOI: 10.1016/j.jvs.2009.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
86
|
Bongers T, de Bruijne E, Dippel D, de Jong A, Deckers J, Poldermans D, de Maat M, Leebeek F. Lower levels of ADAMTS13 are associated with cardiovascular disease in young patients. Atherosclerosis 2009; 207:250-4. [DOI: 10.1016/j.atherosclerosis.2009.04.013] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2008] [Revised: 04/05/2009] [Accepted: 04/06/2009] [Indexed: 01/21/2023]
|
87
|
Poldermans D. Statins and noncardiac surgery: Current evidence and practical considerations. Cleve Clin J Med 2009; 76 Suppl 4:S79-83. [DOI: 10.3949/ccjm.76.s4.13] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
88
|
Winkel TA, Schouten O, van Kuijk JP, Verhagen HJ, Bax JJ, Poldermans D. Perioperative asymptomatic cardiac damage after endovascular abdominal aneurysm repair is associated with poor long-term outcome. J Vasc Surg 2009; 50:749-54; discussion 754. [DOI: 10.1016/j.jvs.2009.04.069] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 04/29/2009] [Accepted: 04/30/2009] [Indexed: 11/26/2022]
|
89
|
Vidakovic R, Schouten O, Kuiper R, Hoeks S, Flu WJ, van Kuijk J, Goei D, Verhagen H, Neskovic A, Poldermans D. The Prevalence of Polyvascular Disease in Patients Referred for Peripheral Arterial Disease. J Vasc Surg 2009. [DOI: 10.1016/j.jvs.2009.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
90
|
Vidakovic R, Schouten O, Kuiper R, Hoeks S, Flu WJ, van Kuijk J, Goei D, Verhagen H, Neskovic A, Poldermans D. The Prevalence of Polyvascular Disease in Patients Referred for Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2009; 38:435-40. [DOI: 10.1016/j.ejvs.2009.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 05/10/2009] [Indexed: 11/16/2022]
|
91
|
Krenning BJ, Geleijnse ML, Poldermans D, Roelandt JRTC. Methodological Analysis of Diagnostic Dobutamine Stress Echocardiography Studies. Echocardiography 2009; 21:725-36. [PMID: 15546374 DOI: 10.1111/j.0742-2822.2004.03161.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Dobutamine stress echocardiography (DSE) is an accepted test for the diagnosis of coronary artery disease (CAD), despite its wide diagnostic accuracy. AIM Which factors cause test variability of DSE for the diagnosis of CAD. METHODS In a retrospective analysis of 46 studies in 5,353 patients, the potential causes of diagnostic variability were systematically analyzed, including patient selection, definition of CAD, chest pain characteristics, confounding factors for DSE (left ventricular hypertrophy, left bundle branch block, female gender), work-up bias (present when patient's chance to undergo coronary angiography is influenced by the result of DSE), review bias (present when DSE is interpreted in relation to CAG), DSE protocol and definition of a positive DSE. RESULTS Diagnostic variability was related to definition of a positive test, but not related to the definition of CAD or DSE protocol. However, only three of eight methodological standards for research design found general compliance. Differences in the selection of the study population (quality of echocardiographic window, angina pectoris), handling of confounding factors and analysis of disease in individual coronary arteries were observed. Lack of data on analysis of relevant chest pain syndromes and handling of nondiagnostic test results hampered further evaluation of these standards. CONCLUSION Methodological problems may explain the wide range in diagnostic variability of DSE. An improvement of clinical relevance of DSE testing is possible by stronger adherence to common and new methodological standards.
Collapse
|
92
|
Schouten O, Boersma E, Hoeks SE, Benner R, van Urk H, van Sambeek MRHM, Verhagen HJM, Khan NA, Dunkelgrun M, Bax JJ, Poldermans D. Fluvastatin and perioperative events in patients undergoing vascular surgery. N Engl J Med 2009; 361:980-9. [PMID: 19726772 DOI: 10.1056/nejmoa0808207] [Citation(s) in RCA: 275] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Adverse cardiac events are common after vascular surgery. We hypothesized that perioperative statin therapy would improve postoperative outcomes. METHODS In this double-blind, placebo-controlled trial, we randomly assigned patients who had not previously been treated with a statin to receive, in addition to a beta-blocker, either 80 mg of extended-release fluvastatin or placebo once daily before undergoing vascular surgery. Lipid, interleukin-6, and C-reactive protein levels were measured at the time of randomization and before surgery. The primary end point was the occurrence of myocardial ischemia, defined as transient electrocardiographic abnormalities, release of troponin T, or both, within 30 days after surgery. The secondary end point was the composite of death from cardiovascular causes and myocardial infarction. RESULTS A total of 250 patients were assigned to fluvastatin, and 247 to placebo, a median of 37 days before vascular surgery. Levels of total cholesterol, low-density lipoprotein cholesterol, interleukin-6, and C-reactive protein were significantly decreased in the fluvastatin group but were unchanged in the placebo group. Postoperative myocardial ischemia occurred in 27 patients (10.8%) in the fluvastatin group and in 47 (19.0%) in the placebo group (hazard ratio, 0.55; 95% confidence interval [CI], 0.34 to 0.88; P=0.01). Death from cardiovascular causes or myocardial infarction occurred in 12 patients (4.8%) in the fluvastatin group and 25 patients (10.1%) in the placebo group (hazard ratio, 0.47; 95% CI, 0.24 to 0.94; P=0.03). Fluvastatin therapy was not associated with a significant increase in the rate of adverse events. CONCLUSIONS In patients undergoing vascular surgery, perioperative fluvastatin therapy was associated with an improvement in postoperative cardiac outcome. (Current Controlled Trials number, ISRCTN83738615.)
Collapse
|
93
|
van Kuijk J, Flu W, Bax J, Poldermans D. Prevalence of (A)Symptomatic Peripheral Arterial Disease; the Additional Value of Ankle–Brachial Index on Cardiovascular Risk Stratification. Eur J Vasc Endovasc Surg 2009; 38:312-3. [DOI: 10.1016/j.ejvs.2009.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Accepted: 05/01/2009] [Indexed: 11/26/2022]
|
94
|
van Kuijk JP, Flu WJ, Voûte MT, Poldermans D, Schouten O. Asymptomatic perioperative cardiac damage: long-term prognosis. Future Cardiol 2009; 5:417-20. [DOI: 10.2217/fca.09.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
95
|
van Gestel YRBM, Hoeks SE, Sin DD, Huzeir V, Stam H, Mertens FW, van Domburg RT, Bax JJ, Poldermans D. COPD and cancer mortality: the influence of statins. Thorax 2009; 64:963-7. [DOI: 10.1136/thx.2009.116731] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
96
|
Flu WJ, van Kuijk JP, Bax JJ, Gorcsan J, Poldermans D. Three-dimensional speckle tracking echocardiography: a novel approach in the assessment of left ventricular volume and function? Eur Heart J 2009; 30:2304-7. [DOI: 10.1093/eurheartj/ehp343] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
|
97
|
Poldermans D, Bax JJ, Boersma E, De Hert S, Eeckhout E, Fowkes G, Gorenek B, Hennerici MG, Iung B, Kelm M, Kjeldsen KP, Kristensen SD, Lopez-Sendon J, Pelosi P, Philippe F, Pierard L, Ponikowski P, Schmid JP, Sellevold OFM, Sicari R, Van den Berghe G, Vermassen F, Vanhorebeek I, Vahanian A, Auricchio A, Bax JJ, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, McGregor K, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas P, Widimsky P, De Caterina R, Agewall S, Al Attar N, Andreotti F, Anker SD, Baron-Esquivias G, Berkenboom G, Chapoutot L, Cifkova R, Faggiano P, Gibbs S, Hansen HS, Iserin L, Israel CW, Kornowski R, Eizagaechevarria NM, Pepi M, Piepoli M, Priebe HJ, Scherer M, Stepinska J, Taggart D, Tubaro M. Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. Eur Heart J 2009; 30:2769-812. [PMID: 19713421 DOI: 10.1093/eurheartj/ehp337] [Citation(s) in RCA: 431] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|
98
|
Winkel TA, Schouten O, Hoeks SE, Verhagen HJM, Bax JJ, Poldermans D. Prognosis of transient new-onset atrial fibrillation during vascular surgery. Eur J Vasc Endovasc Surg 2009; 38:683-8. [PMID: 19683947 DOI: 10.1016/j.ejvs.2009.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 07/10/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Chronic atrial fibrillation (AF) in a non-surgical setting is associated with cardiovascular events. However, the prognosis of transient new-onset AF during vascular surgery is unknown. OBJECTIVE The purpose of this study is to investigate the prognosis of new-onset AF during vascular surgery using continuous electrocardiographic monitoring (continuous-ECG). METHODS In this study, 317 patients, all in sinus rhythm, scheduled for major vascular surgery were screened for cardiac risk factors. Continuous-ECG recordings for 72h and standard ECG on days 3, 7 and 30 were used to identify new-onset AF. Cardiac troponin T (cTnT) was measured routinely after surgery. Study endpoint was a composite of cardiac death, myocardial infarction, unstable angina and stroke (cardiovascular events) at 30 days after surgery and during late follow-up. Median follow-up was 12 (interquartile range 2-28) months. RESULTS New-onset AF was noted in 15 (4.7%) patients. All but three patients returned spontaneously to sinus rhythm. The composite endpoint of cardiovascular events within 30 days and during late follow-up occurred in 34 (11%) and 62 (20%) patients, respectively. Multivariate regression analysis showed that new-onset AF was associated with perioperative (hazard ratio (HR) 6.0; 95% CI: 2.4-15) and late cardiovascular events (HR 4.2, 95% CI: 2.1-8.8). CONCLUSION New-onset AF during vascular surgery is associated with an increased incidence of 30-day and late cardiovascular events.
Collapse
|
99
|
Rizzello V, Poldermans D, Biagini E, Schinkel AFL, Boersma E, Boccanelli A, Marwick T, Roelandt JRTC, Bax JJ. Prognosis of patients with ischaemic cardiomyopathy after coronary revascularisation: relation to viability and improvement in left ventricular ejection fraction. BRITISH HEART JOURNAL 2009; 95:1273-7. [PMID: 19443475 DOI: 10.1136/hrt.2008.163972] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND In patients with ischaemic cardiomyopathy and viable myocardium, left ventricular ejection fraction (LVEF) does not always improve after revascularisation. Whether this may affect prognosis is unclear. OBJECTIVE To evaluate the prognosis of viable patients with and without improvement of LVEF after coronary revascularisation. METHODS Before revascularisation, radionuclide ventriculography (RNV) and dobutamine stress echocardiography were performed to assess LVEF and myocardial viability, respectively. Nine to 12 months after revascularisation, LVEF improvement was assessed by RNV. Patients were divided into three groups: group 1, viable patients with LVEF improvement (n = 27); group 2, viable patients without LVEF improvement (n = 15), group 3, non-viable patients (n = 48). Cardiac events were evaluated during a 4-year follow-up. RESULTS After revascularisation, the mean (SD) LVEF improved from 32 (9)% to 42 (10)% in group 1, but did not change significantly in group 2 and in group 3, p<0.001 by analysis of variance (ANOVA). Heart failure symptoms improved in both groups 1 (mean (SD) NYHA class from 3.1 (0.9) to 1.7 (0.7)) and 2 (from 3.2 (0.7) to 1.7 (0.9)), but not in group 3 (from 2.8 (1.0) to 2.7 (0.5)), p<0.001 by ANOVA. During follow-up, the cardiac event rate was low (4%) in group 1, intermediate (21%) in group 2 and high (33%) in group 3 (p = 0.01). CONCLUSION The best prognosis after revascularisation may be expected in those viable patients whose LVEF improves. Conversely, viable patients without functional improvement have an intermediate prognosis.
Collapse
|
100
|
Flu WJ, van Kuijk JP, Hoeks SE, Kuiper R, Schouten O, Goei D, Winkel T, van Gestel YRBM, Verhagen HJM, Bax JJ, Poldermans D. Intima media thickness of the common carotid artery in vascular surgery patients: a predictor of postoperative cardiovascular events. Am Heart J 2009; 158:202-8. [PMID: 19619695 DOI: 10.1016/j.ahj.2009.05.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Accepted: 05/27/2009] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cardiovascular (CV) complications are the leading cause of morbidity and mortality in vascular surgery patients. The Revised Cardiac Risk (RCR) index, identifying cardiac risk factors, is commonly used for preoperative risk stratification. However, a more direct marker of the underlying atherosclerotic disease, such as the common carotid artery intimamedia thickness (CCA-IMT) may be of predictive value as well. The current study evaluated the prognostic value of the CCA-IMT for postoperative CV outcome. METHODS In 508 vascular surgery patients, the CCA-IMT was measured using high-resolution B-mode ultrasonography. We recorded the RCR factors: ischemic heart disease, heart failure, cerebrovascular disease, diabetes mellitus, and renal dysfunction. Repeated Troponin T measurements and electrocardiograms were performed postoperatively. The study end point was the composite of 30-day CV events and long-term CV mortality. Multivariable regression analyses were used to assess the additional value of CCA-IMT for the prediction of cardiac events. RESULTS In total, 30-day events and long-term cardiovascular mortality were noted in 122 (24%) and 81 (16%) patients, respectively. The optimal predictive value of CCA-IMT, using receiver-operating characteristic curve analysis, for the prediction of CV events was calculated to be 1.25 mm (sensitivity 70%, specificity 80%). An increased CCA-IMT was independently associated with 30-day CV events (OR 2.20, 95% CI 1.38-3.52) and long-term CV mortality (HR 6.88, 95% CI 4.11-11.50), respectively. CONCLUSIONS This study shows that an increased CCA-IMT has prognostic value in vascular surgery patients to predict 30-day CV events and long-term CV mortality, incremental to the RCR index.
Collapse
|