Rohde L E, Polanczyk C A, Goldman L, Cook E F, Lee R T, Lee T H
Partners Community HealthCare Inc, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02199, USA.
Am J Cardiol. 2001 Mar 1;87(5):505-9. doi: 10.1016/s0002-9149(00)01421-1.
Transthoracic echocardiography (TTE) is frequently ordered before noncardiac surgery, although its ability to predict perioperative cardiac complications is uncertain. To evaluate the incremental information provided by TTE after consideration of clinical data for prediction of cardiac complications after noncardiac surgery, 570 patients who underwent TTE before major noncardiac surgery at a university hospital were studied. Preoperative clinical data and clinical outcomes were collected prospectively according to a structured protocol. TTE data included left ventricular (LV) function, hypertrophy indexes, and Doppler-derived measurements. In univariate analyses, preoperative systolic dysfunction was associated with postoperative myocardial infarction (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.1 to 7.0), cardiogenic pulmonary edema (OR 3.2, 95% CI 1.4 to 7.0), and major cardiac complications (OR 2.4, 95% Cl 1.3 to 4.5). Moderate to severe LV hypertrophy, moderate to severe mitral regurgitation, and increased aortic valve gradient were also associated with major cardiac events (OR 2.3, 95% CI 1.2 to 4.6; OR 2.2, 95% CI 1.1 to 4.3; OR 2.1, 95% CI 1.0 to 4.5, respectively). In logistic regression analysis, models with echocardiographic variables predicted major cardiac complications significantly better than those that included only clinical variables (c statistic 0.73 vs 0.68; p <0.05). Echocardiographic data added significant information for patients at increased risk for cardiac complications by clinical criteria, but not in otherwise low-risk patients. In conclusion, preoperative TTE before noncardiac surgery can provide independent information about the risk of postoperative cardiac complications in selected patients.
经胸超声心动图（TTE）在非心脏手术前经常被安排检查，但其预测围手术期心脏并发症的能力尚不确定。为了评估在考虑临床数据后TTE为预测非心脏手术后心脏并发症所提供的增量信息，对一家大学医院570例在非心脏大手术前行TTE检查的患者进行了研究。术前临床数据和临床结局按照结构化方案前瞻性收集。TTE数据包括左心室（LV）功能、肥厚指数以及多普勒衍生测量值。在单因素分析中，术前收缩功能障碍与术后心肌梗死（比值比[OR]2.8，95%置信区间[CI]1.1至7.0）、心源性肺水肿（OR 3.2，95%CI 1.4至7.0）以及主要心脏并发症（OR 2.4，95%CI 1.3至4.5）相关。中度至重度LV肥厚、中度至重度二尖瓣反流以及主动脉瓣梯度增加也与主要心脏事件相关（分别为OR 2.3，95%CI 1.2至4.6；OR 2.2，95%CI 1.1至4.3；OR 2.1，95%CI 1.0至4.5）。在逻辑回归分析中，包含超声心动图变量的模型预测主要心脏并发症的效果显著优于仅包含临床变量的模型（c统计量0.73对0.68；p<0.05）。超声心动图数据为根据临床标准心脏并发症风险增加的患者增加了重要信息，但对其他低风险患者则不然。总之，非心脏手术前的术前TTE可为特定患者术后心脏并发症风险提供独立信息。
