Routine Measurement of Radioisotope Left Ventricular Ejection Fraction Prior to Vascular Surgery: Is it Worthwhile?

Abstract

Twenty-two studies enrolling a total of 3096 patients were identified from 1984 to date. Selection bias, blinding of the results, different cut-off limits, and several retrospective studies were some of the problems preventing a comprehensive analysis. The resting LVEF was not found to be a consistent predictor of perioperative ischaemic cardiac events. In the perioperative phase, poor LV function was, mainly, predictive of congestive heart failure, and, in the long-term, of cardiac outcome. The presence of myocardial wall motion abnormalities was also associated with both a higher chance of postoperative cardiac complications and a worse long-term cardiac outcome. Although measurements of LV function seem to play a key role in defining a patient's long-term prognosis, the value of routinely measuring LVEF preoperatively is limited and, therefore, MUGA scanning cannot be recommended as a general screening test. Despite this, it has been widely used for cardiac risk assessment in vascular surgery, and only recently its popularity has started declining. Other tests, such as stress-echocardiography and myocardial perfusion imaging, used selectively in moderate-risk patients can refine prediction of cardiac risk. In the future, gated stress myocardial perfusion scintigraphy, perhaps combined with ANP/BNP plasma level determination, may become a first choice test in preoperative cardiac risk assessment.

Preexisting right ventricular systolic dysfunction in high-risk patients undergoing non-emergent open abdominal surgery

“…Currently, it is still controversial whether left ventricular (LV) dysfunction, systolic or diastolic, poses as an independent risk factor for perioperative morbidity and mortality in patients undergoing non-cardiac surgery. [ 10 11 12 13 14 ] Moreover, knowledge about the predictive value of right ventricular (RV) dysfunction in non-cardiac surgical cohort is largely unknown. Recently, we published the finding that among high-risk patients undergoing major vascular surgery, preexisting RV systolic dysfunction was more predictive of postoperative MACE than LV systolic dysfunction.…”

Role of Pre‐operative Multiple Gated Acquisition Scanning in Predicting Long‐Term Outcome in Patients Undergoing Elective Abdominal Aortic Aneurysm Repair

“…Conflicting reports in literature specifically assessed the ability of MUGA scans to predict cardiac outcomes in open surgery for AAAs. There is uncertainty as to whether it provides any additional value as opposed to other tests in the short‐term [12, 13]. The specific role of LVEF estimated using MUGA in predicting long‐term survival remains unclear.…”

Peptide natriurétique de type B en post-opératoire immédiat et sa valeur prédictive

“…Les revues r ecentes s'interrogent sur l'utilit e d'une evaluation cardiaque chez ces individus a haut risque en raison de sa faible valeur pr edictive positive. 17,18 De plus, il n'est pas prouv e que les examens d'imagerie non diagnostique conduisent a une strat egie th erapeutique susceptible de r eduire le risque d'infarctus du myocarde p eri-op eratoire ou de d ec es cardiaque. L' evaluation de stress cardiaque chez des patients candidats a une chirurgie vasculaire, effectu ee selon les recommandations de l'American College of Cardiology et/ou de l'American Heart Association concernant l' evaluation p eri-op eratoire avant chirurgie non cardiaque, 19 n'offre pas de valeur ajout ee pour d eterminer la survenue d' ev enement cardiaque post-op eratoire.…”