Multidisciplinary Insights into Perioperative Cardiac Events in Non-Cardiac Surgery: an ECG Holter Monitoring Study
Alexandru Cosmin Palcau1,2, Livia Florentina Paduraru1,3, Alexandru Dinulescu1,4
1"Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Insights
Postoperative cardiovascular events after non-cardiac surgery are linked to inflammation, age, and pre-existing conditions. Holter monitoring identified rhythm and conduction issues, highlighting risks in older patients with hypertension.
Area of Science:
- Cardiology
- Perioperative Medicine
- Surgical Outcomes
Background:
- Cardiovascular complications significantly impact morbidity and mortality following non-cardiac surgery.
- Individualized patient assessment is crucial despite existing risk stratification scores.
Purpose of the Study:
- To identify new cardiac events occurring in the postoperative period after non-cardiac surgery.
Main Methods:
- 100 patients undergoing non-cardiac surgery were monitored using Holter, alongside clinical and biochemical markers (CRP, hscTnI).
- Assessment focused on perioperative cardiac events in patients with surgical pathologies.
Main Results:
- Postoperative atrial fibrillation (AF) occurred in 10% of patients, associated with longer surgery and anemia.
- Sinus pauses correlated with age, history of hypertension, and pre-existing AF.
- ST depression was linked to age, prolonged surgery, hypertension history, and intraoperative blood pressure fluctuations.
Conclusions:
- Advanced age, pre-existing conditions, inflammation, and prolonged surgery increase cardiovascular event risk post-non-cardiac surgery.
- Holter monitoring detected rhythm/conduction disorders and ST changes associated with inflammation and elevated cardiac markers.
- Further research is needed to understand the long-term impact of these cardiac complications.
Background:
Cardiovascular complications after non-cardiac surgery have a major impact on perioperative morbidity and mortality. Despite several scales and scores for assessing the preoperative cardiovascular status, an individualized assessment focused on each patient is mandatory.
Aim:
To identify the new cardiac events that occur after non-cardiac surgery.
Methods:
In 100 patients hospitalized in the general surgery department with acute and chronic surgical pathologies, the perioperative cardiac events were assessed using Holter monitoring along with clinical and biochemical markers, including C reactive protein (CRP) and high-sensitive troponin (hscTnI).
Results:
Out of the 100 participants with a mean age of 54.5 (43-77.9) years, 54% were men. Ten patients developed paroxysmal postoperative atrial fibrillation (AF), which was related with longer surgery time 165 (150-180) vs 120 (90-150) minutes (p=0.002) and postoperative anaemia [haemoglobin (Hg) 10.4 (9.37-12.6) vs 12.1 (11-13.2) g/dL, (p=0.041)]. Higher CRP levels were also correlated with paroxysmal AF. The AF group correlated with higher values of presurgical CRP: 81 (46.5-186.75) vs 27 (6-102.5) mg/dL, (p=0.041). Higher postsurgical CRP values were also found in the AF group: 76 (47.75-110.75) vs 40.5 (12-82.5) mg/dL (p=0.045). Sinus pauses were present in nine patients and there was a strong association between sinus pauses and age (p = 0.011), history of high blood pressure (HBP) (p = 0.031), intraoperative HBP (p = 0.026) and the preexisting AF (p = 0.028). Postsurgical ST changes were present in 30 patients and ST depression was correlated with age (p < 0.001), prolonged surgery time [150 (120-180) vs 120 (90-150) minutes (p < 0.001)], history of HBP [(33.3% vs 12.2%) (p=0.017)] and intraoperative maximum values of BP (p = 0.007).
Conclusions:
There is an increased risk of cardiovascular events during the postoperative period of non-cardiac surgery in patients with advanced age, pre-existing diseases (hypertension, preexisting atrial fibrillation, diabetes mellitus), the level of inflammation and longer intraoperative stress. Holter monitoring revealed rhythm and conduction disorders as well as ST segment changes that were associated with the inflammatory status and slightly elevated cardiac enzyme levels. Future studies are needed to see the impact of cardiac complications in the long term.
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