Document Detail


Routine measurement of radioisotope left ventricular ejection fraction prior to vascular surgery: is it worthwhile?
MedLine Citation:
PMID:  14760589     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine whether estimation of left ventricular (LV) ejection fraction (EF) by means of multiple gated acquisition (MUGA) scanning could reliably stratify cardiac risk prior to elective major vascular surgery. METHODS: A review of the English-language literature. RESULTS AND CONCLUSIONS: Twenty-two studies enrolling a total of 3096 patients were identified from 1984 to date. Selection bias, blinding of the results, different cut-off limits, and several retrospective studies were some of the problems preventing a comprehensive analysis. The resting LVEF was not found to be a consistent predictor of perioperative ischaemic cardiac events. In the perioperative phase, poor LV function was, mainly, predictive of congestive heart failure, and, in the long-term, of cardiac outcome. The presence of myocardial wall motion abnormalities was also associated with both a higher chance of postoperative cardiac complications and a worse long-term cardiac outcome. Although measurements of LV function seem to play a key role in defining a patient's long-term prognosis, the value of routinely measuring LVEF preoperatively is limited and, therefore, MUGA scanning cannot be recommended as a general screening test. Despite this, it has been widely used for cardiac risk assessment in vascular surgery, and only recently its popularity has started declining. Other tests, such as stress-echocardiography and myocardial perfusion imaging, used selectively in moderate-risk patients can refine prediction of cardiac risk. In the future, gated stress myocardial perfusion scintigraphy, perhaps combined with ANP/BNP plasma level determination, may become a first choice test in preoperative cardiac risk assessment.
Authors:
C D Karkos; M S Baguneid; F Triposkiadis; E Athanasiou; P Spirou
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery     Volume:  27     ISSN:  1078-5884     ISO Abbreviation:  Eur J Vasc Endovasc Surg     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-02-04     Completed Date:  2004-03-30     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  9512728     Medline TA:  Eur J Vasc Endovasc Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  227-38     Citation Subset:  IM    
Affiliation:
Department of Cardiovasculr and Thoracic Surgery, University of Thessalia Medical School, Larissa, Grece. ckarkos@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Gated Blood-Pool Imaging* / utilization
Heart Diseases / etiology*
Humans
Myocardial Ischemia / etiology
Preoperative Care
Risk Assessment
Stroke Volume
Vascular Surgical Procedures* / adverse effects

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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