Prognostic value of left ventricular systolic function before vascular surgery: a systematic review

Area of Science:

• Cardiology
• Vascular Surgery
• Echocardiography

Background:

• Vascular surgery is associated with a high risk of post-operative cardiac complications.
• Asymptomatic left ventricular systolic dysfunction is linked to increased major adverse cardiovascular events (MACE).

Purpose of the Study:

• To evaluate the prognostic value of left ventricular ejection fraction (LVEF) measured by resting echocardiography before vascular surgery.

Main Methods:

• Systematic review adhering to PRISMA and MOOSE guidelines.
• Searched PubMed, OVID Medline, and Cochrane databases up to October 2022.
• Included multivariable-adjusted or propensity-matched observational studies assessing LVEF and cardiac outcomes in vascular surgery patients.

Main Results:

• Ten observational studies with 4872 patients were included.
• A trend towards increased all-cause mortality, congestive heart failure, and MACE was observed in patients with pre-operative LVEF <50%.
• Moderate methodological quality was noted; meta-analysis was precluded by study heterogeneity.

Conclusions:

• Evidence on the prognostic value of pre-operative LVEF in vascular surgery is currently weak and inconclusive.
• Larger, prospective studies are needed to improve cardiac risk prediction before vascular surgery.