Dzhioeva Olga, Tadic Marijana, Belyavskiy Evgeny
Department of Therapy and Preventive Medicine, Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, 127473 Moscow, Russia.
Klinik für Innere Medizin II, Universitätsklinikum Ulm, 89081 Ulm, Germany.
Rev Cardiovasc Med. 2023 Mar 23;24(4):98. doi: 10.31083/j.rcm2404098. eCollection 2023 Apr.
The current guidelines from various medical societies provide a good summary of data regarding various preoperative exercise tests in patients prior to non-cardiac surgical interventions. However, there is no consensus among experts on the appropriateness of these methods for identifying risk groups for potential perioperative complications. A large volume of published studies describes the role of preoperative exercise stress testing impact in improving the prediction of potential cardiovascular (CV) risk in patients after non-cardiac surgery. Numerous stress tests are available in clinical practice, and the methods used and the best choice depends on the purpose of the study and the availability of equipment in the hospital. Traditionally, the value of exercise electrocardiography (ECG), or ECG stress test, has been based on the belief that it is beneficial for perioperative cardiac risk prediction. However, in the past two decades, the key role of this method has lost its importance due to the growing trend toward the use of imaging techniques. Moreover, in light of current trends, the six-minute walk test (6MWT) is a helpful tool in preoperative assessment and plays an important role in postoperative rehabilitation. Interestingly, the recent finding showed how 6MWT affects the risk of postoperative complications. Cardiopulmonary testing, as a dynamic clinical tool, determines the cardiorespiratory status of a patient. Various clinical indications for cardiopulmonary exercise testing include evaluation of therapy, stratification of risk factors, diagnosis of disease, and control of physical activity. Stress testing is one of the most practical ways of predicting perioperative risk and managing patients. This test is based on ischemia provoked by pharmacological agents or exercise. There is no established evidence of a significant advantage of pharmacological stress over exercise stress imaging in subjects who are capable enough to be physically active. All of these studies examined a stress test for induced myocardial ischemia. Currently, there are no data on the use of ischaemic stress tests, especially diastolic stress tests, in the assessment of perioperative risk before non-cardiac surgical interventions. We consider it promising and essential to continue research in this direction in patients with coronary heart disease and other categories of cardiac patients, in particular, comorbid and low-symptomatic individuals, before elective high-risk surgical interventions.
各医学协会的现行指南很好地总结了非心脏手术干预前患者各种术前运动测试的数据。然而，专家们对于这些方法在识别潜在围手术期并发症风险组方面的适用性尚未达成共识。大量已发表的研究描述了术前运动应激测试对改善非心脏手术后患者潜在心血管（CV）风险预测的作用。临床实践中有多种应激测试，所使用的方法和最佳选择取决于研究目的和医院设备的可用性。传统上，运动心电图（ECG）或心电图应激测试的价值基于其对围手术期心脏风险预测有益的信念。然而，在过去二十年中，由于成像技术使用的增加趋势，这种方法的关键作用已失去重要性。此外，根据当前趋势，六分钟步行测试（6MWT）是术前评估中的一个有用工具，并且在术后康复中发挥重要作用。有趣的是，最近的研究发现显示了6MWT如何影响术后并发症的风险。心肺测试作为一种动态临床工具，可确定患者的心肺状态。心肺运动测试的各种临床适应症包括治疗评估、风险因素分层、疾病诊断和身体活动控制。应激测试是预测围手术期风险和管理患者的最实用方法之一。该测试基于药物或运动诱发的缺血。在有足够身体活动能力的受试者中，没有确凿证据表明药物应激比运动应激成像具有显著优势。所有这些研究都检查了诱发心肌缺血的应激测试。目前，在非心脏手术干预前的围手术期风险评估中，关于使用缺血应激测试，尤其是舒张期应激测试，尚无数据。我们认为，在冠心病患者和其他类别心脏病患者，特别是合并症患者和低症状个体中，在择期高风险手术干预前继续朝这个方向进行研究是有前景且必不可少的。
