Value of myocardial viability estimation using dobutamine stress echocardiography in assessing risk preoperatively before noncardiac vascular surgery in patients with left ventricular ejection fraction <35%.
ABSTRACT Patients with heart failure (HF) scheduled for vascular surgery have an increased risk of adverse postoperative outcome, and stratification usually depends on dichotomous risk factors. A quantitative prognostic model for patients with HF was developed using wall motion patterns during dobutamine stress echocardiography (DSE). A total of 295 consecutive patients (mean age 67 +/- 12 years) with ejection fraction < or =35% were studied. During DSE, wall motion patterns of dysfunctional segments were scored as scar, ischemia, or sustained improvement. Cardiac death and myocardial infarction were noted perioperatively and during 5 years of follow-up. Of 4,572 dysfunctional segments; 1,783 (39%) had ischemia, 1,280 (28%) had sustained improvement, and 1,509 (33%) had scar. In 212 patients, > or =1 ischemic segment was present; 83 had only sustained improvement. Perioperative and late cardiac event rates were 20% and 30%, respectively. Using multivariate analysis, number of ischemic segments was associated with perioperative cardiac events (odds ratio per segment 1.6, 95% confidence interval 1.05 to 1.8), whereas number of segments with sustained improvement was associated with improved outcome (odds ratio per segment 0.2, 95% confidence interval 0.04 to 0.7). Multivariate independent predictors of late cardiac events were age and ischemia. Sustained improvement was associated with improved survival. In conclusion, DSE provides accurate risk stratification of patients with HF undergoing vascular surgery.
- SourceAvailable from: Luc A PierardRevista Espa de Cardiologia 12/2009; 62(12):1467. · 3.20 Impact Factor
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ABSTRACT: In the course of the “atopic march”, sensitization to food allergens appears earliest, followed by sensitization to inhalant allergens, which is a factor favoring the subsequent development of asthma. While the sequence atopic dermatitis and/or food sensitization (allergy)–asthma–allergic rhinitis is usually the case, exceptions to this schema are relatively frequent. Asthma and food allergy, conditions occurring more and more often, are closely linked, especially in children. Note that bronchospasm can be a symptom of food allergy. Note also that asthmatic disease is one of the principal risk factors for severe anaphylaxis and death associated with food allergy, with recognized under-utilization of auto-injectable adrenalin. Conversely, because of the “intrinsic” severity of asthma, food allergy represents an important risk factor for severe acute asthma, being able to put the life, especially that of young children, adolescents and young adults, in danger. In practice, one must: (I) look for a history of asthma or existing asthma in all patients suspected of having food allergy, (II) be assured of optimal control of asthma diagnosed during the course of a food allergy workup, and (III) in all cases, refer the patient to an allergy specialist, because experience proves that one food allergic patient out of two does not benefit from such a consultation and the resulting special recommendations.Revue Francaise D Allergologie - REV FR ALLERGOL. 01/2011; 51(3):248-254.
Article: Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery: the Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA).European Journal of Anaesthesiology 02/2010; 27(2):92-137. · 2.79 Impact Factor