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.
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ABSTRACT: Bariatric surgery is the most effective treatment of obesity and its associated diseases like type 2 diabetes mellitus. Given the obesity epidemic and the efficacy of surgical treatment, the number of surgical weight loss procedures has grown in recent years. Nevertheless, there is little consensus regarding the extent of preoperative investigations required prior to patients undergoing surgery. This article aims to discuss the available evidence on which preoperative tests are useful for the detection and treatment of conditions such as venous thromboembolism, obstructive sleep apnea syndrome and Helicobacter pylori-positive gastritis prior to an operation. The present literature suggests that only a few preoperative investigations are essential, but that preoperative multidisciplinary care is beneficial. © 2014 S. Karger AG, Basel.Digestive surgery 01/2014; 31(1):25-32. DOI:10.1159/000354553 · 1.74 Impact Factor
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ABSTRACT: Worldwide, annually approximately 100 million people undergo some form of non-cardiac surgery. Cardiac events, such as myocardial infarction are a major cause of perioperative morbidity and mortality in these patients. Though the true incidence of perioperative cardiac complications is difficult to assess, it is estimated that approximately 2.0–3.5% of patients undergoing major non-cardiac surgery experience a major adverse cardiac event. Furthermore an estimated 0.5–1.5% of patients die within 30 days after the surgical procedure due to a cardiovascular cause. The pathophysiology of perioperative cardiac events is complex. Similar to the non-operative setting it is thought that approximately half of all perioperative myocardial infarctions are attributable to a sustained coronary oxygen demand/supply mismatch. Coronary plaque rupture, leading to thrombus formation and subsequent vessel occlusion, is thought to be the other important cause of acute perioperative coronary syndromes.
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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 Française d Allergologie 04/2011; 51(3):248-254. DOI:10.1016/j.reval.2011.01.015 · 0.22 Impact Factor