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Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
Preoperative cardiac evaluation is unnecessary in most patients undergoing vascular operations
K M Itani1, C C Miller, G Guinn
1Department of Surgery, Houston Veterans Affairs Medical Center and Baylor College of Medicine, Texas 77030, USA.
Insights
Clinical assessment effectively predicts cardiac outcomes in vascular surgery patients. Extensive cardiac testing is best reserved for those with high Goldman
Area of Science:
- Cardiology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Evaluating predictive value of Goldman's index (GI), radionuclide ventriculography (RVG), and dipyridamole-thallium scintigraphy (DTS) for cardiac outcomes post-vascular operations.
- Assessing 463 patients undergoing vascular surgery, categorized by DTS results (no DTS, reversible ischemia, no reversible ischemia).
Purpose of the Study:
- To determine the efficacy of GI, RVG, and DTS in predicting cardiac complications and outcomes in patients undergoing vascular surgery.
- To identify optimal strategies for cardiac testing in this high-risk population.
Main Methods:
- Collected data on Goldman's index, ejection fraction, wall motion abnormalities, coronary angiography rates, and revascularization.
- Compared these parameters across patient groups defined by dipyridamole-thallium scintigraphy results.
Main Results:
- Goldman's index was significantly higher in patients who died postoperatively (6.1) compared to survivors (3.6).
- Dipyridamole-thallium scintigraphy and radionuclide ventriculography did not reliably predict mortality, morbidity, or need for coronary revascularization.
- Coronary revascularization rates were similar across groups: 8% (no DTS), 7% (no ischemia), and 9% (ischemia).
Conclusions:
- Clinical assessment, particularly Goldman's index, remains a strong predictor of cardiac outcome in vascular surgery patients.
- Intensive cardiac testing should be prioritized for patients with elevated Goldman's index and active cardiac issues.
Background:
This study evaluated the impact of Goldman's index (GI), radionuclide ventriculography (RVG), and dipyridamole-thallium scintigraphy (DTS) on predicting cardiac outcome after vascular operations.
Methods:
A total of 463 consecutive patients undergoing vascular operations were divided into those who had no DTS, those who had reversible ischemia by DTS, and those who had no reversible ischemia by DTS. GI, ejection fraction, wall motion abnormalities, rate of coronary angiography, and revascularization were determined for each group.
Results:
Coronary revascularization was ultimately performed in 8% of patients with no DTS, 7% of patients with no ischemia by DTS, and 9% of patients with ischemia by DTS. The GI of 6.1 in patients who died postoperatively was significantly higher than the GI of 3.6 in patients who survived (P = 0.02). RVG did not predict mortality, morbidity, or need for coronary revascularization.
Conclusion:
Clinical assessment remains a good predictor for cardiac outcome in patients undergoing vascular operations. More extensive cardiac testing should be reserved for patients with higher GI and active cardiac problems.
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