Prevalence and pharmacological treatment of left‐ventricular dysfunction in patients undergoing vascular surgery

Abstract

AimsThis study evaluated the prevalence of left-ventricular (LV) dysfunction in vascular surgery patients and pharmacological treatment, according ESC guidelines. Methods and resultsEchocardiography was performed pre-operatively in 1005 consecutive patients. Left ventricular ejection fraction (LVEF) 50% defined systolic LV dysfunction. Diastolic LV dysfunction was diagnosed based on E/A-ratio, pulmonary vein flow, and deceleration time. Optimal pharmacological treatment to improve LV function was considered as: (i) angiotensin-blocking agent (ACE-I/ARB) in patients with LVEF 40%; (ii) ACE-I/ARB and b-blocker in patients with LVEF 40% þ heart failure symptoms or previous myocardial infarction; and (iii) a diuretic in patients with symptomatic heart failure, regardless of LVEF. Left-ventricular dysfunction was present in 506 patients (50%), of whom 209 (41%) had asymptomatic diastolic LV dysfunction, 194 (39%) had asymptomatic systolic LV dysfunction, and 103 (20%) had symptomatic heart failure. Treatment with ACE-I/ARB and/or b-blocker could be initiated/improved in 67 (34%) of the 199 patients with (a)symptomatic LVEF 40%. A diuretic could be initiated in 32 patients (31%) with symptomatic heart failure (regardless of LVEF). ConclusionsThis study demonstrates a high prevalence of LV dysfunction in vascular surgery patients and under-utilization of ESC recommended pharmacological treatment. Standard pre-operative evaluation of LV function could be argued based on our results to reduce this observed care gap.--

Nationwide trends in development of heart failure and mortality after first-time myocardial infarction 1997–2010: A Danish cohort study

“…Other studies have also used the method for quantifying the severity of HF based on the amount of used loop diuretics [14,15]. It has also been shown in earlier studies that the majority of HF patients used loop diuretics [33,34]. Although it is possible that some patients could have been prescribed loop diuretics for kidney disease rather than HF we believe that such misclassification would be unlikely to confound our results in the direction of a false improvement in the incidence of HF.…”

Prognostic Implications of Asymptomatic Left Ventricular Dysfunction in Patients Undergoing Vascular Surgery

“…The study population has been previously described and consisted of 1,005 consecutive vascular surgery patients under-going elective (open or endovascular) lower extremity artery, carotid artery, or abdominal aorta repair. 10 This prospective cohort study was performed at the Erasmus Medical Center in Rotterdam, The Netherlands, during the period of 2002-2008. The study was approved by the ethics committee of the hospital, and written informed consent was obtained from all patients.…”

Heart failure severity, as determined by loop diuretic dosages, predicts the risk of developing diabetes after myocardial infarction: a nationwide cohort study

“…Moreover, as patients with the use of loop diuretics prior to MI hospitalization were excluded from the present study cohort, the indication for loop diuretic treatment was in most cases likely to be HF. The sensitivity of using loop diuretics as a proxy for HF was considered acceptable, as the majority of HF patients have previously been reported to use loop diuretics 10,11…”