Prognostic value of preoperative echocardiography in predicting myocardial injury after open abdominal aortic surgery.
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INTRODUCTION: Abdominal aortic aneurysms (AAAs) and peripheral arterial and aortic diseases (PAADs) are associated with increased risk of myocardial injury after noncardiac surgery (MINS). OBJECTIVES: 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. PATIENTS AND METHODS: 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. RESULTS: 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). CONCLUSIONS: Our study suggests that routine preoperative TTE may be moderately useful in the prediction of MINS among patients undergoing high‑risk vascular surgery.
