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Cardiac risk stratification of patients with symptomatic spinal stenosis
T Faciszewski1, R Jensen, R Rokey
1Marshfield Clinic, WI 54449, USA.
Insights
Many older adults undergoing lumbar surgery have silent heart disease. Cardiac stress testing revealed 8% had ischemia, recommending screening for those with heart disease or smoking history.
Area of Science:
- Cardiology
- Neurosurgery
- Geriatric Medicine
Background:
- Cardiac events are a leading cause of perioperative death after noncardiac surgery.
- The increasing number of lumbar surgeries in patients over 65 necessitates understanding their cardiac risks.
- Neurogenic claudication patients over 65 often have co-existing cardiac risk factors.
Purpose of the Study:
- To determine the prevalence of silent ischemic heart disease in patients with neurogenic claudication undergoing elective lumbar surgery.
- To identify risk factors associated with cardiac ischemia in this patient population.
Main Methods:
- Cardiac chemical stress testing was employed to assess myocardial ischemia.
- 140 patients with neurogenic claudication considered for elective lumbar surgery were included.
Main Results:
- 8% (11 of 140) of patients demonstrated induced cardiac wall abnormalities, indicative of myocardial ischemia.
- Smoking and a history of heart disease were the only identified risk factors for cardiac ischemia.
Conclusions:
- Dobutamine stress echocardiography is recommended for patients undergoing elective spinal surgery for symptomatic spinal stenosis.
- Screening should be prioritized for patients with a history of heart disease and/or smoking.
Abstract:
The leading cause of death in the perioperative period after noncardiac surgery is a cardiac event. As the number of lumbar surgeries performed in patients older than 65 years of age continues to increase, this patient population with neurogenic claudications is an at risk group for a cardiac event because of their age and associated cardiac risk factors. The authors attempted to document by means of cardiac chemical stress testing, the prevalence of silent ischemic cardiac disease in patients with neurogenic claudication who were candidates for elective lumbar surgery. Eleven of 140 patients (8%) had induced cardiac wall abnormalities on stress testing, indicating myocardial ischemia. The only risk factors associated with cardiac ischemia were smoking and history of heart disease. It is recommended that dobutamine stress echocardiography be performed in patients undergoing elective spinal surgery for symptomatic spinal stenosis if they have a history of previous heart disease, smoking, or both.