ROUTINE PREOP ECHO IN VASCULOPATHS IDENTIFIES FREQUENT SUBCLINICAL LV DYSFUNCTION, WHICH CARRIES A POOR PROGNOSIS

The prolific folks from Erasmus report on 1005 consecutive vascular surgery patients studied with preop transthoracic echo.  A few salient findings:

  • Periop 30d MACE is roughly twice as common with endovascular compared to open repair (even after “Multivariate analysis adjusted for age, gender, ischemic heart disease, cerebrovascular disease, renal dysfunction, diabetes mellitus, hypertension, hypercholesterolemia, chronic obstructive pulmonary disease, and smoking.)
  • Only 1/2 of the patients had normal LV function
  • Asymptomatic LV dysfunction (either systolic and diastolic) is associated with worse outcome

The results suggest that perhaps routine preop echo should be part of the preop workup before vascular surgery.  However, the authors cannot prove that the knowledge gained would lead to changes in practice that would improve outcome.  They do suggest that patients whose preop echoes identify subclinical LV dysfunction might benefit from having beta blockers and ACEI or ARBs started.

We have an article in press suggesting that there are significant variations in anesthesiologists’ desire for preop echo before vascular surgery.

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One Response to “ROUTINE PREOP ECHO IN VASCULOPATHS IDENTIFIES FREQUENT SUBCLINICAL LV DYSFUNCTION, WHICH CARRIES A POOR PROGNOSIS”

  1. […] always been concerned about the generalizability of Poldermans’ work.  A PubMed search of his name and “vascular surgery” returns over 150 references. […]

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