Preoperative Assessment of Endothelial Function for Prediction of Adverse Events After Cardiovascular Surgery

Abstract

Background: Cardiovascular surgery is one of the highest risk procedures in the field of surgery. Preoperative assessment of endothelial function has been reported as useful for predicting postoperative adverse events (AEs). The aim of this study was to investigate the relationship between endothelial function assessed by reactive hyperemia index (RHI) and AEs after cardiovascular surgery. Methods and Results:A prospective observational study of 197 patients who underwent cardiovascular surgery was conducted. RHI was measured before the surgery. The primary endpoint was a composite of postoperative death, reoperation, stroke, newly required dialysis, deep sternum infection, and prolonged ventilation within 30 days. The secondary endpoint was new-onset atrial fibrillation (AF) within 30 days. Following cardiovascular surgery, 19 patients (9.6%) had AEs. New-onset AF was documented in 42 (25.9%) of 162 patients without a prior history of AF. In the receiver-operating characteristic curve analysis, RHI significantly predicted AEs (area under the curve [AUC] 0.67, best cutoff value 1.64, P=0.03), whereas RHI did not predict new-onset AF (AUC 0.53, P=0.93). Patients with RHI ≤1.64 had more AEs than those with RHI >1. 64 (16.3% vs. 4.5%, P=0.005). Multiple logistic regression analysis showed the number of surgical procedures and RHI ≤1.64 as significant predictors of AEs. Conclusions:Preoperative endothelial dysfunction assessed by RHI was associated with postoperative AEs in patients with cardiovascular surgery.

Impact of Serum Uric Acid Level on Systemic Endothelial Dysfunction in Patients with a Broad Spectrum of Ischemic Heart Disease

“…Systemic endothelial function was assessed with reactive hyperemic index (RHI) using the EndoPAT 2000 device (Itamar Medical Inc., Caesarea, Israel), which is validated to evaluate endothelial function non-invasively, operator-independently, and reproducibly [ 22 ]. RHI was measured as previously described [ 6 , 8 , 9 , 10 , 11 , 12 , 19 ]. Briefly, patients fasted and refrained from taking caffeine, tobacco, and all medications for at least eight hours.…”

“…Patients with antihyperuricemic agents were excluded. A study (n = 197) enrolled patients planned for elective cardiovascular surgery, among whom, 70 underwent isolated or concomitant CABG procedures (registered at the University Hospital Medical Information Network Clinical Trials Registry: UMIN000015135) [9,10]. After excluding 18 patients who received antihyperuricemic agents, 52 were included in the present analysis (CCS-CABG group).…”

Impact of glycemic variability on coronary and peripheral endothelial dysfunction in patients with coronary artery disease

“…Pneumatic finger probes were applied to both index fingers, and pulsatile volume changes within probes were continuously recorded during baseline period for 5 min, occlusion period by inflation of a blood pressure cuff on the tested arm for 5 min, and post-deflation period for another 5 min. Then, the EndoPAT 20 0 0 device automatically calculated RHI [27][28][29].…”

The effect of remote ischaemic preconditioning on endothelial function after hip fracture surgery

“…The extent of endothelial dysfunction after surgery seems to be influenced by perioperative factors such as type of surgery, anaesthetics and pain 3,5‐7 . While pre‐operative endothelial dysfunction has been associated with the risk of developing perioperative major adverse cardiovascular events 8‐10 the clinical consequences of endothelial dysfunction in the perioperative period remain to be established. Endothelial dysfunction early after surgery may play a role in the pathophysiology of myocardial injury 11 …”