Abstract
Purpose of the study. Evaluation of the value of the results of the use of cardiac functional examination methods for the stratification of the risk of developing cardiovascular complications in planned abdominal surgical interventions in patients over 65 years of age or with cardiac pathology.Materials and methods. The study included 179 patients over 65 years of age or with a history of heart disease who underwent elective abdominal surgery. The median age was 70 years. During the operation and for 30 days after it, cardiac complications were recorded: severe (myocardial infarction, stroke, death from cardiovascular disease), others (strokes of exertional angina, ischemic dynamics of the ST segment on the electrocardiogram – ECG – rest, paroxysmal fibrillation / flutter atrial). All patients underwent basic examination – examination, anamnesis, ECG, blood test, assessment of respiratory function, ECG monitoring. Additionally, echocardiography (EchoCG) and ergospirometry (ESM) were performed.Results. In 30 (16.8 %) patients, various MTRs were detected: 6 (3.4 %) of fatal myocardial infarctions, 2 (1.1 %) of fatal strokes; 3 (1.7 %) cases of sudden cardiac death, angina attacks were recorded in 4 (2.2 %) patients, 7 (3.9 %) had ischemic ECG dynamics, 11 (6.1 %) had fibrillation episodes or atrial flutter. Chronic obstructive pulmonary disease, intervention on the colon, blood hemoglobin level <100 g / l, serum creatinine >103 μmol / l, presence of any pathological changes in the resting ECG were associated with the development of SSO; according to EchoCG – VTI (linear velocity integral) in the outflow tract of the left ventricle (LV) <21.5 cm, volume of the left atrium> 57 ml, global LV myocardial deformity is less than 18 %, increase in heart rate (HR) at the 1st minute load test> 27 %, peak oxygen consumption at ESM <15.8 ml / kg / min. The optimal plan for preoperative examination in men is to perform a basic model, and for women it is advisable to combine a basic examination with an ESM or an assessment of the degree of myocardial deformity using the speckle-tracking method for EchoCG.Conclusion. The risk of perioperative MTS during planned abdominal operations in patients older than 65 years or with a history of heart disease is relatively high – 16.8 %. When assessing the risk associated with the operation, it is advisable to additionally conduct echocardiography with VTI assessment in the LV outflow tract and myocardial deformity indicators, as well as ESM with the determination of HR increase in the 1st minute of the test and peak oxygen consumption.
Highlights
Intervention on the colon, blood hemoglobin level 103 μmol / l, presence of any pathological changes in the resting ECG were associated with the development of SSO; according to EchoCG – VTI in the outflow tract of the left ventricle (LV) 57 ml, global LV myocardial deformity is less than 18 %, increase in heart rate (HR) at the 1st minute load test> 27 %, peak oxygen consumption at ESM
The optimal plan for preoperative examination in men is to perform a basic model, and for women it is advisable to combine a basic examination with an ESM or an assessment of the degree of myocardial deformity using the speckle-tracking method for EchoCG
When assessing the risk associated with the operation, it is advisable to conduct echocardiography with VTI assessment in the LV outflow tract and myocardial deformity indicators, as well as ESM with the determination of HR increase in the 1st minute of the test and peak oxygen consumption
Summary
* – данные представлены в виде медиан (25‐й процентиль; 75‐й процентиль); ** – диагноз установлен по данным медицинской документации. Ствия, АД, ЧСС, выполняли дополнительные исследования по показаниям. Конечные точки исследования были разделены на 2 группы – большие ССО (смерть от кардиальной причины, ИМ, инсульт) и малые ССО (приступы стенокардии с характерной динамикой сегмента ST и волны Т на ЭКГ, пароксизмы фибрилляции или трепетания предсердий). Клинико-демографическая характеристика пациентов перед хирургическим вмешательством представлена в табл. 2. Результаты У 30 (16,8 %) пациентов выявлены различные периоперационные ССО, в том числе большие – у 12 (6,7 %) Частота различных ССО в зависимости от вида хирургического вмешательства представлена в табл. Рак желудка Рак толстой кишки Желчнокаменная болезнь Грыжа (паховая, белой линии живота) Рак пищевода Грыжа пищеводного отверстия диафрагмы Рак поджелудочной железы Язва двенадцатиперстной кишки или желудка
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have