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. 2019 Apr 25;14(4):e0215854.
doi: 10.1371/journal.pone.0215854. eCollection 2019.

Application of transthoracic echocardiography in patients receiving intermediate- or high-risk noncardiac surgery

Hsien-Yuan Chang  1   2 , Wei-Ting Chang  3   4 , Yen-Wen Liu  1   2
Affiliations

Application of transthoracic echocardiography in patients receiving intermediate- or high-risk noncardiac surgery

Hsien-Yuan Chang et al. PLoS One. .

Abstract

Background: Cardiovascular events are the leading cause of perioperative complications among patients undergoing noncardiac surgery. However, the role of echocardiography for preoperative cardiac risk stratification prior to major noncardiac surgery is still controversial.

Methods: This retrospective study included a total of 1453 patients (51% male; age, 67 ± 16) who underwent intermediate- or high-risk major abdominal surgery or orthopedic surgery at two medical centers in South Taiwan between February 2013 and June 2016. All patients underwent preoperative transthoracic echocardiography (TTE). All of the included patients were followed up for 56 days after surgery. The primary endpoints were major adverse events (MAEs), i.e., all-cause mortality and major adverse cardiovascular-cerebral events (MACCEs).

Results: A total of 35 patients (2.4%) reached the primary endpoint: 24 patients (1.6%) died, and 17 patients (1.2%) had MACCEs. Patients with postsurgery MAEs had higher average E/e' values, a lower Left ventricular (LV) ejection fraction, and higher prevalence of significant mitral regurgitation (MR) and moderate-advanced chronic kidney disease (CKD). Multivariate analysis showed that the modified Lee index and significant MR were independent prognostic predictors of MAEs.

Conclusion: Preoperative identification of significant MR on TTE is associated with increased MAEs at 56 days compared with that predicted by the modified Lee index alone in patients undergoing intermediate- or high-risk noncardiac surgery.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Consort diagram for patient inclusion.
Fig 2
Fig 2. Kaplan-Meier curve of cumulative MAE-free survival.
A. A modified Lee index score >1 was associated with more MAEs than a modified Lee index score = 1 (p<0.001 by log-rank test). B. Patients with at least moderate MR had more MAEs than patients without moderate MR (p < 0.001).
Fig 3
Fig 3. Incremental prognostic information of the modified Lee index, average E/e’ >14, EF < 40%, and significant MR.
Based on a comparison of the overall log likelihood χ2 of the predictive power, there was no incremental prognostic information for MAE between Condition l and Condition 2 or between Condition 1 and Condition 3. Only Condition 4 added incremental prognostic power compared with Condition 1 (p = 0.028).
See this image and copyright information in PMC

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