Preoperative identification of significant mitral regurgitation on transthoracic echocardiography was independently associated with increased major adverse events at 56 days post-surgery.
Cohort (n=1,453)
Yes
Does preoperative transthoracic echocardiography improve risk stratification for major adverse events in patients undergoing intermediate- or high-risk noncardiac surgery?
Preoperative identification of significant mitral regurgitation on transthoracic echocardiography provides incremental prognostic value over the modified Lee index for predicting 56-day major adverse events in patients undergoing intermediate- or high-risk noncardiac surgery.
BACKGROUND: Cardiovascular events are the leading cause of perioperative complications among patients undergoing noncardiac surgery. However, the role of echocardiography for preoperative cardiac risk stratification prior to major noncardiac surgery is still controversial. METHODS: This retrospective study included a total of 1453 patients (51% male; age, 67 ± 16) who underwent intermediate- or high-risk major abdominal surgery or orthopedic surgery at two medical centers in South Taiwan between February 2013 and June 2016. All patients underwent preoperative transthoracic echocardiography (TTE). All of the included patients were followed up for 56 days after surgery. The primary endpoints were major adverse events (MAEs), i.e., all-cause mortality and major adverse cardiovascular-cerebral events (MACCEs). RESULTS: A total of 35 patients (2.4%) reached the primary endpoint: 24 patients (1.6%) died, and 17 patients (1.2%) had MACCEs. Patients with postsurgery MAEs had higher average E/e' values, a lower Left ventricular (LV) ejection fraction, and higher prevalence of significant mitral regurgitation (MR) and moderate-advanced chronic kidney disease (CKD). Multivariate analysis showed that the modified Lee index and significant MR were independent prognostic predictors of MAEs. CONCLUSION: Preoperative identification of significant MR on TTE is associated with increased MAEs at 56 days compared with that predicted by the modified Lee index alone in patients undergoing intermediate- or high-risk noncardiac surgery.
Chang et al. (Thu,) conducted a cohort in Intermediate- or high-risk noncardiac surgery (n=1,453). Significant mitral regurgitation on preoperative TTE vs. Absence of significant mitral regurgitation was evaluated on Major adverse events (MAEs), including all-cause mortality and major adverse cardiovascular-cerebral events (MACCEs). Preoperative identification of significant mitral regurgitation on transthoracic echocardiography was independently associated with increased major adverse events at 56 days post-surgery.