Karkos Christos D, Thomson George J L, Hughes Robert, Joshi Miland, Baguneid Mohamed S, Hill Jonathan C, Mukhopadhyay Umasankar S
Department of Vascular Surgery, Royal Preston Hospital, Preston PR2 9HT, UK.
World J Surg. 2003 Oct;27(10):1085-92. doi: 10.1007/s00268-003-6970-3. Epub 2003 Aug 21.
Debate continues regarding the value of cardiac testing before major vascular surgery. Studies looking at whether a low radioisotope left ventricular ejection fraction (LVEF) could reliably predict postoperative cardiac events have produced conflicting results. Technetium-99m multiple gated acquisition (MUGA) scanning was employed in 122 patients undergoing elective abdominal aortic aneurysm surgery to estimate the resting LVEF and to detect regional or global myocardial wall motion abnormalities (WMAs). Adverse cardiac outcomes were predicted using logistic regression analysis. Among this group of patients, 20 did not proceed to surgery for a variety of reasons, and 102 underwent surgical repair. More than half of the patients (55%) had a history of cardiac disease. The mean +/- SD LVEF was 55.5% +/- 11.1%. Altogether, 31 patients had WMAs, and 21 had both WMAs and an abnormal LVEF (< or = 50%). Altogether, 20 cardiac complications were encountered in 17 patients (17%). Logistic regression analysis identified four significant predictors of cardiac complications: history of cardiac disease [odds ratio (OR) 10.43; 95% confidence interval (CI) 1.3 and 80.5], the presence of WMAs (OR 10.1, CI 1.4 and 74.6), additional procedures (OR 12.1, CI 1.4 and 103.0), and reoperation during the postoperative period (OR 6.4, CI 1.4 and 30.4). This is the largest reported British series of cardiac testing using MUGA scans prior to abdominal aortic reconstruction. Only the presence of WMAs (not the resting LVEF) was useful for predicting postoperative cardiac events. A history of cardiac disease, additional procedures, and reoperation during the postoperative period also place a patient at high risk for cardiac complications. A normal LVEF is by no means reassuring that a patient is at low risk of suffering an adverse cardiac outcome.
关于大血管手术前心脏检查的价值，目前仍存在争议。一些研究探讨低放射性核素左心室射血分数（LVEF）是否能可靠预测术后心脏事件，结果相互矛盾。对122例行择期腹主动脉瘤手术的患者采用锝-99m门控心血池显像（MUGA）扫描，以评估静息LVEF并检测局部或整体心肌壁运动异常（WMA）。采用逻辑回归分析预测不良心脏结局。在这组患者中，20例因各种原因未进行手术，102例接受了手术修复。超过一半的患者（55%）有心脏病史。平均±标准差LVEF为55.5%±11.1%。共有31例患者存在WMA，21例既有WMA又有异常LVEF（≤50%）。17例患者（17%）共出现20例心脏并发症。逻辑回归分析确定了心脏并发症的四个重要预测因素：心脏病史[比值比（OR）10.43；95%置信区间（CI）1.3和80.5]、存在WMA（OR 10.1，CI 1.4和74.6）、额外手术（OR 12.1，CI 1.4和103.0）以及术后再次手术（OR 6.4，CI 1.4和30.4）。这是英国报道的最大规模的一组在腹主动脉重建术前使用MUGA扫描进行心脏检查的系列研究。只有WMA的存在（而非静息LVEF）对预测术后心脏事件有用。心脏病史、额外手术以及术后再次手术也使患者发生心脏并发症的风险较高。LVEF正常并不能保证患者发生不良心脏结局的风险较低。
