Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 May;94(5):826-832.
doi: 10.1111/ans.18866. Epub 2024 Feb 2.

Prognostic value of left ventricular systolic function before vascular surgery: a systematic review

Ammar Zaka  1   2 , Daud Mutahar  2 , Kreyen Ponen  1 , Johayer Abtahi  1 , Naim Mridha  3 , Aman B Williams  1 , Mohammed Kamali  1 , Joshua G Kovoor  4 , Stephen Bacchi  5 , Aashray K Gupta  1   4 , Peter J Psaltis  4   6 , Venu Bhamidipaty  1
Affiliations

Prognostic value of left ventricular systolic function before vascular surgery: a systematic review

Ammar Zaka et al. ANZ J Surg. 2024 May.

Abstract

Background: Vascular surgery carries a high risk of post-operative cardiac complications. Recent studies have shown an association between asymptomatic left ventricular systolic dysfunction and increased risk of major adverse cardiovascular events (MACE). This systematic review aims to evaluate the prognostic value of left ventricular function as determined by left ventricular ejection fraction (LVEF) measured by resting echocardiography before vascular surgery.

Methods: This review conformed to PRISMA and MOOSE guidelines. PubMed, OVID Medline and Cochrane databases were searched from inception to 27 October 2022. Eligible studies assessed vascular surgery patients, with multivariable-adjusted or propensity-matched observational studies measuring LVEF via resting echocardiography and providing risk estimates for outcomes. The primary outcomes measures were all-cause mortality and congestive heart failure at 30 days. Secondary outcome included the composite outcome MACE.

Results: Ten observational studies were included (4872 vascular surgery patients). Studies varied widely in degree of left ventricular systolic dysfunction, symptom status, and outcome reporting, precluding reliable meta-analysis. Available data demonstrated a trend towards increased incidence of all-cause mortality, congestive heart failure and MACE in patients with pre-operative LVEF <50%. Methodological quality of the included studies was found to be of moderate quality according to the Newcastle Ottawa Checklist.

Conclusion: The evidence surrounding the prognostic value of LVEF measurement before vascular surgery is currently weak and inconclusive. Larger scale, prospective studies are required to further refine cardiac risk prediction before vascular surgery.

Keywords: echocardiography; ejection fraction; left ventricular dysfunction; vascular surgery.

PubMed Disclaimer

References

    1. Poldermans D, Bax JJ, Boersma E et al. Guidelines for pre‐operative cardiac risk assessment and perioperative cardiac management in non‐cardiac surgery. Eur. Heart J. 2009; 30: 2769–2812.
    1. Fleisher LA, Fleischmann KE, Auerbach AD et al. ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force On Practice Guidelines. Circulation 2014; 130: 2215–2245.
    1. Lerman BJ, Popat RA, Assimes TL, Heidenreich PA, Wren SM. Association between heart failure and postoperative mortality among patients undergoing ambulatory noncardiac surgery. JAMA Surg. 2019; 154: 907–914.
    1. Schouten O, Dunkelgrun M, Feringa HH et al. Myocardial damage in high‐risk patients undergoing elective endovascular or open infrarenal abdominal aortic aneurysm repair. Eur. J. Vasc. Endovasc. Surg. 2007; 33: 544–549.
    1. Halvorsen S, Mehilli J, Cassese S et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non‐cardiac surgery. Eur. Heart J. 2022; 43: 3826–3924.

Publication types

MeSH terms

LinkOut - more resources