Prognostic value of preoperative echocardiography in predicting myocardial injury after open abdominal aortic surgery

Abdominal aortic aneurysms (AAAs) and peripheral arterial and aortic diseases (PAADs) are associated with increased risk of myocardial injury after noncardiac surgery (MINS).

Our aim was to evaluate whether preoperative transthoracic echocardiography (TTE) abnormalities are linked to MINS in patients undergoing open vascular surgeries involving the abdominal aorta due to AAA and / or PAAD.

We analyzed a retrospective cohort of consecutive patients who underwent open abdominal aortic surgery due to infrarenal AAA and / or aortoiliac occlusive disease in a single tertiary center. In each patient, TTE was performed within 1-3 months before the surgery and at least 2 postoperative high‑sensitive troponins were measured (on the first and second postoperative day), as per the standard of care at the center.

The study group comprised 336 patients. Their median (interquartile range) age was 67 (63-74) years, and 82.7% of the patients were men. MINS was diagnosed in 122 individuals (36.3%). A multivariable analysis showed that myocardial hypokinesis, as compared with normal contractility, was associated with a higher risk of MINS (odds ratio [OR], 3.23; 95% CI, 1.3-8.03). A similar association was not found for left ventricular ejection fraction (OR, 1.08; 95% CI, 0.78-1.48), left ventricular septum hypertrophy (OR, 1.58; 95% CI, 0.91-2.75), increased left atrium surface (OR, 0.95; 95% CI, 0.54-1.7), or mitral insufficiency (OR, 0.89; 95% CI, 0.5-1.58).

Our study suggests that routine preoperative TTE may be moderately useful in the prediction of MINS among patients undergoing high‑risk vascular surgery.