Incidence of electrocardiographic alterations in the preoperative period of non-cardiac surgery.

BACKGROUND: The electrocardiogram is the most widely used test to assess cardiovascular risk during the preoperative period. The objective of the present study is to evaluate the incidence of electrocardiographic alterations in the general population scheduled for non-cardiac surgery and to determine if the age greater than or equal to 65 years or the revised cardiac risk index ≥1 represent a risk factor for presenting these alterations. MATERIAL AND METHODS: Over a period of one month, all preoperative electrocardiograms (ECG) from the anesthesia clinic were analyzed. Various epidemiological data were collected and the revised cardiac risk index was calculated. Major alterations were defined as those requiring Cardiology follow-up. RESULTS: 476 patients were recruited, of whom 40.8% were ≥65 years, 32.6% had HTN, 14.4% DM and 27.9% dyslipidemia. 16.16% of the patients had a Lee Index ≥1. Of the entire sample, 80.5% had a normal ECG, 6.5% minor alterations and 13.0% major alterations. In the multivariate analysis, age ≥65 years and the presence of HTN were shown as independent risk factors for presenting alterations in the total and major ECG. The Lee index ≥1 was not associated with an increased risk of electrocardiographic abnormalities. CONCLUSIONS: Patients ≥65 years old and those with HTN are at greater risk of presenting major electrocardiographic abnormalities, so we recommend including the ECG as a routine diagnostic test in the preoperative period of non-cardiac surgery.

Incidence of electrocardiographic alterations in the preoperative period of non-cardiac surgery. / Incidencia de alteraciones electrocardiográficas en el preoperatorio de cirugía no cardiaca.

BACKGROUND: The electrocardiogram is the most widely used test to assess cardiovascular risk during the preoperative period. The objective of the present study is to evaluate the incidence of electrocardiographic alterations in the general population scheduled for non-cardiac surgery and to determine if the age greater than or equal to 65 years or the revised cardiac risk index ≥ 1 represent a risk factor for presenting these alterations. MATERIAL AND METHODS: Over a period of one month, all preoperative electrocardiograms (ECG) from the anesthesia clinic were analyzed. Various epidemiological data were collected and the revised cardiac risk index was calculated. Major alterations were defined as those requiring Cardiology follow-up. RESULTS: 476 patients were recruited, of whom 40.8% were ≥ 65 years, 32.6% had HTN, 14.4% DM and 27.9% dyslipidemia. 16.16% of the patients had a Lee Index ≥ 1. Of the entire sample, 80.5% had a normal ECG, 6.5% minor alterations and 13.0% major alterations. In the multivariate analysis, age ≥ 65 years and the presence of HTN were shown as independent risk factors for presenting alterations in the total and major ECG. The Lee index ≥ 1 was not associated with an increased risk of electrocardiographic abnormalities. CONCLUSIONS: Patients ≥ 65 years old and those with HTN are at greater risk of presenting major electrocardiographic abnormalities, so we recommend including the ECG as a routine diagnostic test in the preoperative period of non-cardiac surgery.

Patient General Condition at Diagnosis: A Systematic Evaluation for Adults Diagnosed with Hematologic Malignancies.

Several societies have published recommendations for evaluating older adults with cancer in standard conditions. It is vital to assure a proper systematic patient condition evaluation, not only in the oldest (geriatric assessment) but in all adult patients. We have investigated the feasibility of a systematic evaluation of the general condition of all patients diagnosed with hematologic malignancies, and the degree of acceptance by the clinical team, in a prospective cohort of 182 consecutive adults, by using the ECOG performance status scale (ECOG, age 18 and over, 18+), Lee Index for Older Adults (LEE, 50+), Geriatric Assessment in Hematology (GAH, 65+), and the Comprehensive Geriatric Assessment (CGA, 75+). Clinical team acceptance was analyzed with a visual analogue scale, and the objective feasibility was calculated as the proportion of patients that could be finally evaluated with each tool. Acceptance was high, but the objective feasibility was progressively lower as the complexity of the different tools increased (ECOG 100%, LEE 99.4%, GAH 93.2%, and CGA 67.9%). LEE and GAH categories showed a weak concordance (Cohen's Kappa 0.24) that was slight between LEE and CGA (Kappa 0.18). Unexpectedly, we found no significant association between the GAH and CGA categories (p = 0.16). We confirm that a systematic evaluation of all adult patients diagnosed with hematologic malignancies is feasible in daily practice by using an age-adapted approach. Direct comparisons among the different predictive tools in regard to patients' tolerance to treatments of different intensities must be a priority research subject in the coming years.

Effect of High Fat Diets on Body Mass, Oleylethanolamide Plasma Levels and Oxytocin Expression in Growing Rats.

Obesity prevalence in developed countries has promoted the need to identify the mechanisms involved in control of feeding and energy balance. We have tested the hypothesis that different fats present in diet composition may contribute in body weight gain and body indexes by regulation of oxytocin gene (oxt) expression in hypothalamus and Oleylethanolamide (OEA) levels in plasma. Sprague-Dawley rats were fed two high fat diets, based on corn (HCO) and extra virgin olive oil (HOO) and results were compared to a low fat diet (LF). LC-MS/MS analysis showed an increasing trend of OEA plasma levels in HOO group, although no significant differences were found. However, body weight gain of LF and HOO were similar and significantly lower than HCO. HCO rats also had higher Lee index than HOO. Rats fed HOO diet showed higher levels of hypothalamic oxt mRNA expression, which could indicate that oxytocin may be modulated by dietary lipids.

Sensibilidad, especificidad y valores predictivos de los índices cardíacos de Goldman, Detsky y Lee / Sensitivity, specificity and predictive values of the Goldman, Detsky and Lee cardiac indices

Introducción: Reconocer oportunamente las variables de riesgo perioperatorio permite predecir la frecuencia de morbimortalidad, así como tomar medidas a fin de reducir complicaciones. Para ello se han creado varias escalas de riesgo en pacientes portadores de enfermedad cardiovascular. Objetivo: Determinar la sensibilidad, la especificidad y los valores predictivos de los índices de riesgo cardíaco de Goldman, Detsky y Lee para cirugía no cardíaca. Método: Se realizó un estudio observacional, analítico, longitudinal y prospectivo del total de pacientes portadores de enfermedad cardiovascular con enfermedad quirúrgica no cardíaca en el período comprendido entre enero de 2011 y enero de 2013 en el Hospital Universitario Manuel Ascunce Domenech de la ciudad de Camagüey. La muestra estuvo constituida por 88 pacientes comprendidos en el universo que cumplieron con los criterios de inclusión. Las variables estudiadas fueron: edad, sexo, tipo de cirugía, tipo de complicación, y la presencia o no de estas en relación con el riesgo catalogado según los índices de Goldman, Detsky y Lee. Se aplicó prueba de sensibilidad, especificidad y valores predictivos. Resultados: Predominaron los pacientes mayores de 70 años, el sexo masculino, la cirugía ortopédica; la arritmia cardíaca fue la principal complicación. Fue frecuente encontrar pacientes de alto riesgo, en los cuales la mayoría sufrieron complicaciones. Conclusiones: Los índices de Goldman y Detsky mostraron alta sensibilidad y especificidad, y el índice de Lee, mayor valor predictivo positivo. No obstante, deben aplicarse los 3 índices predictivos para lograr una óptima estratificación del riesgo cardíaco en cirugía no cardíaca.

Introduction: Timely recognition of perioperative risk variables helps predict morbidity and mortality frequency, as well as adopt measures to reduce complications. Several risk scores have been developed for this purpose in patients with cardiovascular disease. Objective: To determine the sensitivity, specificity and predictive values of the Goldman, Detsky and Lee cardiac risk indices for non-cardiac surgery. Methods: Observational, analytical, longitudinal prospective study of the total number of patients with cardiovascular disease undergoing non-cardiac surgery between January 2011 and January 2013 at Hospital Universitario Manuel Ascunce Domenech in Camagüey. The sample consisted of 88 patients included in the universe of patients who met the inclusion criteria. The variables studied were: age, gender, type of surgery, type of complication, and the presence or absence of complications in relation to the risk assessed on the basis of the Goldman, Detsky and Lee indices. The sensitivity, specificity and predictive value test was applied. Results: There was a predominance of males in patients over 70 years of age coming for orthopaedic surgery; cardiac arrhythmiawas the main complication. High-risk patients were a frequent finding and the majority suffered complications. Conclusions: The Goldman and Detsky indices showed high sensitivity and specificity, while the Lee index showed higher positive predictive value. However, the three predictive indices must be applied in order to optimize cardiac risk stratification in non-cardiac surgery.