Heart rate variability and cardiac troponin I are incremental and independent predictors of one-year all-cause mortality after major noncardiac surgery in patients at risk of coronary artery disease

Filipovic, Miodrag; Jeger, Raban; Probst, C; Girard, Thierry; Pfisterer, Matthias; Gürke, Lorenz; Skarvan, K.; Seeberger, Manfred D.

doi:10.1016/j.jacc.2003.05.008

Cited by 103 publications

(92 citation statements)

References 38 publications

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“…The results of research on LF ⁄ HF are inconsistent, even in patients with underlying cardiac disease. In two recent studies, Filipovic et al demonstrated that LF ⁄ HF < 2.0 was an independent predictor of long-term mortality, cardiac events [12] and all-cause mortality after major non-cardiac surgery [29]. In contrast to our findings, they found a depressed baseline LF ⁄ HF (< 2) indicated a greater risk of adverse events.…”

Section: Discussioncontrasting

confidence: 99%

Does heart rate variability predict hypotension and bradycardia after induction of general anaesthesia in high risk cardiovascular patients?*

et al. 2008

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SummaryThis study investigated whether heart rate variability predicts haemodynamic events in high risk patients, defined as Revised Cardiac Risk Index score = 3, scheduled for general anaesthesia. Fifty patients underwent baseline measurement of heart rate variability and were then assigned according to haemodynamic events (hypotension or bradycardia) after standardised induction of anaesthesia into 'stable' (n = 39) and 'unstable' patients (n = 11). Unstable patients had significantly lower baseline total power. Total power < 500 ms 2 .Hz )1 was associated with high sensitivity and specificity for the prediction of hypotension or bradycardia. Prospectively, 29 patients with total power < 500 ms 2 .Hz )1 were compared with 21 patients with total power > 500 ms 2 .Hz )1 . Differences were found in the lowest mean arterial pressure and heart rate after induction of anaesthesia. We conclude that the pre-operative total power of heart rate variability in high risk patients may indicate the occurrence of haemodynamic events with high sensitivity and specificity. Heart rate variability may be a suitable tool to identify patients at high risk of a haemodynamic event and may be used to indicate need for intensive monitoring and, perhaps, prophylactic treatment. Patients with underlying cardiovascular disease are at high risk of peri-operative cardiovascular events and death [1,2]. Adverse events during anaesthesia and surgery may increase the risk further in this patient population. Specifically, following induction of general anaesthesia, hypotension and bradycardia are often observed and may lead to insufficient organ perfusion and ischaemic events [3][4][5]. Haemodynamic parameters are controlled, to some extent, by the autonomic nervous system. The activity of the autonomic nervous system is reflected in the heart rate variability (HRV) [6][7][8]. Several authors have demonstrated depressed long-term HRV in patients with underlying cardiovascular disease [9][10][11] and HRV has proved to be highly predictive for cardiovascular morbidity and mortality in these patients [12][13][14]. Recently, short-term HRV analysis (5 min) has been shown to be a reliable tool to predict hypotension after spinal anaesthesia [15,16]. The low to high frequency ratio (LF ⁄ HF) was demonstrated to be a highly sensitive parameter to predict hypotension [17] and LF ⁄ HF-guided prophylactic therapy was able to prevent hypotension [18]. Only preliminary data have been published on the incidence of hypotension or bradycardia after induction of general anaesthesia in patients with underlying autonomic dysfunction [19,20]. A retrospective subgroup analysis of a small number of patients with diabetes demonstrated that pre-operative depression of sympathetic and parasympathetic activity was correlated with a significantly greater incidence of hypotension after induction of anaesthesia. However, these results were not confirmed prospectively.This study was designed to investigate the predictive power of HRV in patients with underlying cardiovascu...

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Section: Discussioncontrasting

confidence: 99%

Does heart rate variability predict hypotension and bradycardia after induction of general anaesthesia in high risk cardiovascular patients?*

et al. 2008

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“…The 6 eligible studies, [25][26][27][28][29][30] which included a total of 2175 patients and 249 events (Table 2), evaluated CK-MB, 26,27,29,30 troponin T, [28][29][30] troponin I 25,27 or both troponin T and I. 26 In all 6 studies, troponin measurement proved to be a statistically significant independent predictor of intermediate and long-term outcomes (i.e., mortality and major cardiac events).…”

Section: Box 1: Proposed Diagnostic Criteria For Perioperative Myocarmentioning

confidence: 99%

“…25,28 In contrast, 3 of the 4 studies that assessed CK-MB failed to show an association between an elevated CK-MB value and intermediate or long-term outcomes. 26,27,29,30 The authors of one of the studies 27 published a second paper evaluating the same patients but excluding deaths in the first month after surgery and extending the follow-up period from 1 to 2 years. 31 In this second paper, an elevated perioperative troponin value did not significantly predict the few deaths between months 1 to 24 after surgery (odds ratio 2.7, 95% CI 0.7-10), 31 which suggests that an elevated perioperative troponin value more strongly predicts mortality in the first 12 months after surgery.…”

Section: Box 1: Proposed Diagnostic Criteria For Perioperative Myocarmentioning

confidence: 99%

Surveillance and prevention of major perioperative ischemic cardiac events in patients undergoing noncardiac surgery: a review

Devereaux

Goldman²,

Yusuf³

et al. 2005

Canadian Medical Association Journal

210

114

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Review SynthèseT his is the second of 2 articles in which we evaluate cardiac events in patients undergoing noncardiac surgery. In the first article, we established that patients undergoing noncardiac surgery frequently experience major perioperative cardiac events (i.e., cardiac death, nonfatal myocardial infarction [MI] and nonfatal cardiac arrest). 1 We discussed the still unresolved pathophysiology of these events and suggested strategies for preoperative cardiac risk assessment and communication of risk. In this article, we summarize the evidence regarding monitoring strategies for perioperative MI, propose diagnostic criteria for perioperative MI and review the evidence for perioperative prophylactic cardiac interventions.The breadth of the topics covered in this article prohibited a fully systematic approach to this review. Although this is a narrative review, we did conduct thorough literature searches in each area and contacted the authors of relevant articles when necessary. We sought relevant systematic reviews and have highlighted their findings in our discussion.

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“…This may result in an inferior predictive value of LF ⁄ HF in patients with underlying cardiovascular disease. In two recent studies, Filipovic et al demonstrated that LF ⁄ HF < 2.0 was an independent risk factor of longterm mortality, cardiac events, and all-cause mortality after major non-cardiac surgery [7,26]. We tested LF ⁄ HF < 2 for prediction of postoperative cardiac events, but the sensitivity and specificity were low.…”

Section: Discussionmentioning

confidence: 99%

Use of heart rate variability analysis to determine the risk of cardiac ischaemia in high‐risk patients undergoing general anaesthesia

et al. 2008

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SummaryThe aim of this study was to investigate the use of pre-operative heart rate variability analysis to predict postoperative cardiac events (identified by 24 h Holter-ECG recording and an increase of creatine kinase MB) in high-risk cardiac patients. Length of hospital stay, the incidence of postoperative cardiac ischaemia and cardiac events after discharge were recorded. Fifty patients were assigned by the presence of cardiac events and the heart rate variability in 17 patients with an event was compared with 33 patients without. Total power was identified as a predictive parameter. The usefulness of this test was assessed in a second group of 50 patients. The incidence of cardiac events detected by Holter-ECG recording or an increased creatine kinase MB was greater and the duration of hospital stay longer in the 26 patients with total power < 400 ms 2 .Hz )1 compared with those with total power > 400 ms 2

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Heart rate variability and cardiac troponin I are incremental and independent predictors of one-year all-cause mortality after major noncardiac surgery in patients at risk of coronary artery disease

Cited by 103 publications

References 38 publications

Does heart rate variability predict hypotension and bradycardia after induction of general anaesthesia in high risk cardiovascular patients?*

Does heart rate variability predict hypotension and bradycardia after induction of general anaesthesia in high risk cardiovascular patients?*

Surveillance and prevention of major perioperative ischemic cardiac events in patients undergoing noncardiac surgery: a review

Use of heart rate variability analysis to determine the risk of cardiac ischaemia in high‐risk patients undergoing general anaesthesia

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