Association of Left Ventricular Ejection Fraction and Symptoms With Mortality After Elective Noncardiac Surgery Among Patients With Heart Failure

Lerman, Benjamin J; Popat, Rita A.; Assimes, Themistocles L.; Heidenreich, Paul A.; Wren, Sherry M.

doi:10.1001/jama.2019.0156

Cited by 96 publications

(94 citation statements)

References 32 publications

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“…[24][25][26] Among patients undergoing noncardiac surgery, patients with heart failure and increasing severity of LV systolic dysfunction exhibited higher risk of total mortality after surgery. 27 Despite the above, there is a relative paucity of prognostic studies in a broad range of hospitalized patients.…”

Section: Discussionmentioning

confidence: 99%

Association of Left Ventricular Ejection Fraction with Mortality and Hospitalizations

Angaran

Dorian

et al. 2020

Journal of the American Society of Echocardiography

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Background: Although echocardiography is widely used to measure left ventricular ejection fraction (LVEF), its prognostic value has not been demonstrated in a broad range of patients including those acutely hospitalized for cardiac or noncardiac causes. We determined whether greater degrees of left ventricular systolic dysfunction were associated with progressively increasing risks of death or cardiovascular hospitalizations among patients in hospital or outpatient settings. Methods: A total of 27,323 patients with LVEF measured and 19,445 matched controls were followed for 223,034 person-years. Outcomes of total mortality, cardiovascular death, cardiovascular hospitalizations, and heart failure hospitalizations were examined using cause-specific hazard competing-risks analysis.

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Section: Discussionmentioning

confidence: 99%

Association of Left Ventricular Ejection Fraction with Mortality and Hospitalizations

Angaran

Dorian

et al. 2020

Journal of the American Society of Echocardiography

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“…The most important comorbidities associated with postoperative death are cirrhosis, congestive heart failure and coronary artery disease [2]. In a large database study of more than 600,000 patients, those with heart failure undergoing complex surgery had a 90-day mortality of more than 10% [3]. Based on the strong association of cardiac diseases with perioperative mortality, many efforts were made to stratify the risk and optimize the outcomes of patients at risk of cardiac issues when undergoing major non-cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

Biomarker-Based Preoperative Risk Stratification for Patients Undergoing Non-Cardiac Surgery

Yurttas

Hidvegi

Filipovic

2020

JCM

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Perioperative morbidity and mortality remains a substantial problem and is strongly associated with patients’ cardiac comorbidities. Guidelines for the cardiovascular assessment and management of patients at risk of cardiac issues while undergoing non-cardiac surgery are traditionally based on the exclusion of active or unstable cardiac conditions, determination of the risk of surgery, the functional capacity of the patient, and the presence of cardiac risk factors. In the last two decades, strong evidence showed an association between cardiac biomarkers and adverse cardiac events, with newer guidelines incorporating this knowledge. This review describes a biomarker-based risk-stratification pathway and discusses potential treatment strategies for patients suffering from postoperative myocardial injury or infarction.

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Section: Introductionmentioning

confidence: 99%

“…Heart failure (HF) is associated with postoperative mortality among patients undergoing elective non-cardiac surgery [1]. It is related to left ventricular (LV) reduced systolic function, but by recent report, it is not always dependent on systolic function [1,2]. Among patients undergoing elective noncardiac surgery, 7.9% patients have already had a clinical HF with and without symptoms, and in those patients, 60% had documented preserved ejection fraction (EF) [1].…”

Section: Introductionmentioning

confidence: 99%

“…It is related to left ventricular (LV) reduced systolic function, but by recent report, it is not always dependent on systolic function [1,2]. Among patients undergoing elective noncardiac surgery, 7.9% patients have already had a clinical HF with and without symptoms, and in those patients, 60% had documented preserved ejection fraction (EF) [1]. Nearly half of all HF patients are HF with preserved EF (HFpEF), and their morbidity and mortality are similar to those with reduced EF [1,3].…”

Section: Introductionmentioning

confidence: 99%

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Preoperative elevated E/e’ (≥ 15) with preserved ejection fraction is associated with the development of postoperative heart failure in intermediate-risk non-cardiac surgical patients

et al. 2020

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Purpose Left ventricular diastolic dysfunction is an independent risk factor for adverse cardiovascular morbidities and mortalities in cardiovascular and high-risk surgical patients. However, there were only a few investigations among intermediaterisk surgical patients. This study aimed to investigate postoperative heart failure (HF) in intermediate-risk surgical patients who had preoperative diastolic dysfunction with preserved ejection fraction (EF). Methods Consecutive patients underwent intermediate-risk surgery between January 2016 and December 2018 were retrospectively evaluated. Patients with preserved EF were divided into three groups using one of the parameters of diastolic function: the ratio of early diastolic filling velocity to the peak diastolic velocity of mitral medial annulus (E/e') ≥ 15, E/e' between 8 and 15, and E/e' < 8. Postoperative HF was defined as clinical symptoms and radiological evidence and low SpO 2 less than 93%. The primary outcome was the incidence of postoperative HF and its relation to preoperative E/e'. Chi-squared test, unpaired t test with Welch's correction, and multivariate logistic regression were used for analysis. Results In total, 965 patients were included in the final analysis. Postoperative HF developed in 36/965 (3.7%) patients with preserved EF. The incidence of postoperative HF was stratified according to the E/e', and the rates of HF occurrence in patients with E/e' < 8, 8-15, and ≥ 15 were 1.8%, 2.7%, and 15%, respectively (P < 0.01). Conclusion Preoperative elevated E/e' (≥ 15) was associated with the development of postoperative HF in intermediate-risk surgical patients with preserved EF.

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Association of Left Ventricular Ejection Fraction and Symptoms With Mortality After Elective Noncardiac Surgery Among Patients With Heart Failure

Cited by 96 publications

References 32 publications

Association of Left Ventricular Ejection Fraction with Mortality and Hospitalizations

Association of Left Ventricular Ejection Fraction with Mortality and Hospitalizations

Biomarker-Based Preoperative Risk Stratification for Patients Undergoing Non-Cardiac Surgery

Preoperative elevated E/e’ (≥ 15) with preserved ejection fraction is associated with the development of postoperative heart failure in intermediate-risk non-cardiac surgical patients

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