Routine measurement of radioisotope left ventricular ejection fraction prior to vascular surgery: is it worthwhile?
Eur J Vasc Endovasc Surg
; 27(3): 227-38, 2004 Mar.
Article
en En
| MEDLINE
| ID: mdl-14760589
ABSTRACT
OBJECTIVE:
To determine whether estimation of left ventricular (LV) ejection fraction (EF) by means of multiple gated acquisition (MUGA) scanning could reliably stratify cardiac risk prior to elective major vascular surgery.METHODS:
A review of the English-language literature. RESULTS ANDCONCLUSIONS:
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.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Procedimientos Quirúrgicos Vasculares
/
Imagen de Acumulación Sanguínea de Compuerta
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Cardiopatías
Tipo de estudio:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Humans
Idioma:
En
Revista:
Eur J Vasc Endovasc Surg
Asunto de la revista:
ANGIOLOGIA
Año:
2004
Tipo del documento:
Article
País de afiliación:
Grecia
Pais de publicación:
ENGLAND
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ESCOCIA
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GB
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GREAT BRITAIN
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INGLATERRA
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REINO UNIDO
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SCOTLAND
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UK
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UNITED KINGDOM