Transthoracic Echocardiography Provides Important Long-Term Prognostic Information in Selected Patients Undergoing Endovascular Abdominal Aortic Repair

Abstract

Background— The value of performing transthoracic echocardiography (TTE) as part of the clinical assessment of patients awaiting endovascular repair of the abdominal aorta is little evaluated. We aimed to estimate the prognostic importance of information derived from TTE on long-term all-cause mortality in a selected group of patients undergoing endovascular aneurysm repair. Methods and Results— This was a retrospective cohort study of 273 consecutive patients selected for endovascular aneurysm repair. All patients included in the analysis underwent TTE before their procedure. Multivariable Cox regression analysis was used to estimate the effect of TTE measures on all-cause mortality. Over a mean follow-up of 3.2±1.5 years, there were 78 deaths with a mean time to death of 1.28±1.16 years. A greater tubular ascending aorta (hazard ratio [HR] 5.6, 95% confidence interval [CI] 2.77–11.33), presence of mitral regurgitation (HR 8.13, 95% CI 4.09–12.16), lower left ventricular ejection fraction (HR 0.96, 95% CI 0.93–0.98), younger age (HR 0.97, 95% CI 0.95–0.99), and presence of diabetes mellitus (HR 1.46, 95% CI 1.24–1.89) were predictors of all-cause mortality. Conclusions— Echocardiography provides important long-term prognostic information in patients undergoing endovascular aneurysm repair. These TTE indices were more important at predicting outcome than standard conventional risk factors in this patient group. A greater tubular ascending aorta, presence of mitral regurgitation, reduced left ventricular ejection fraction, younger age, and diabetes mellitus were independently associated with long-term mortality.

Assessments of Physical Workload in Sonography Tasks Using Inclinometry, Goniometry, and Electromyography

“…O'Driscoll et al. [30] showed that the self-selected hand position was 35° of extension and 7° of ulnar deviation, when testing grip strength. We have also shown in a previous study that the risk of elbow/hand disorders increase with increasing palmar flexion [31] .…”

Preoperative Transthoracic Echocardiography in Abdominal Aortic Aneurysm

“…To date, the evidence in support of additional testing to reduce intermediate and long-term morbidity and mortality is limited. In this issue of Circulation: Cardiovascular Imaging, O'Driscoll et al 10 seek to extend previous work on risk assessment by evaluating the prognostic value of transthoracic echocardiography (TTE) in patients slated for elective EVAR. Using a retrospective cohort design, the authors studied 273 consecutive patients undergoing elective EVAR between January 2008 and September 2010.…”

“…As described by the authors, after accounting for demographics, clinical history, medications, and laboratory measures, 3 TTE indices-of 26 reported-were found to be significant predictors of long-term outcome (ie, mortality). 10 have provided informative insights into the assessment of long-term risk assessment in patients slated to undergo elective EVAR. We congratulate the authors for taking this first step into AAA risk assessment.…”

“…6,9,11,12 The changes in the patterns of mortality are mirrored in cardiovascular disease-driven outcomes in general, which have declining for decades. 13 The causes of death predicted by TTE in the work by O'Driscoll et al 10 takes on a heightened importance in this setting, as current causes of death in their study are unknown. Indeed, many of these limitations are noted by the authors.…”

Reflected wave intensity increases based on aortic diameter after endovascular aortic therapy in a goat model

“…EVAR is recommended for elderly patients with aortic aneurysm as a substitute for conventional aortic grafting. However, it has been reported that cardiovascular events and deaths increase during the long-term follow-up period after EVAR 1,2 . A greater ascending aorta diameter, presence of mitral regurgitation, reduced left ventricular (LV) ejection fraction, younger age, diabetes mellitus, and the female sex were independently associated with long-term mortality after EVAR 2,3 .…”