Use of the multiple-uptake gated acquisition scan for the preoperative assessment of cardiac risk

1989 ◽  
Vol 3 (2) ◽  
pp. 244
Keyword(s):  
Preoperative Assessment ◽  
Cardiac Risk ◽  
Gated Acquisition

scholarly journals A Novel Technique for the Assessment of Preoperative Cardiovascular Risk: Reactive Hyperemic Response to Short-Term Exercise

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Robert Schier ◽  
Jochen Hinkelbein ◽  
Hanke Marcus ◽  
Ashley Smallwood ◽  
Arlene M. Correa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vascular Function ◽  
Reactive Hyperemia ◽  
Surrogate Marker ◽  
Preoperative Assessment ◽  
Cardiac Risk ◽  
Short Term ◽  
Exact Test ◽  
Cardiac Risk Factors ◽  
Hyperemic Response

Background. Perioperative vascular function has been widely studied using noninvasive techniques that measure reactive hyperemia as a surrogate marker of vascular function. However, studies are limited to a static setting with patients tested at rest. We hypothesized that exercise would increase reactive hyperemia as measured by digital thermal monitoring (DTM) in association to patients' cardiometabolic risk.Methods. Thirty patients (58 ± 9 years) scheduled for noncardiac surgery were studied prospectively. Preoperatively, temperature rebound (TR) following upper arm cuff occlusion was measured before and 10 minutes after exercise. Data are presented as means ± SD. Statistical analysis utilized ANOVA and Fisher’s exact test, withPvalues <0.05 regarded as significant.Results. Following exercise, TR-derived parameters increased significantly (absolute: 0.53 ± 0.95 versus 0.04 ± 0.42∘C,P=0.04, and % change: 1.78 ± 3.29 versus 0.14 ± 1.27 %,P=0.03). All patients with preoperative cardiac risk factors had a change in TR (after/before exercise, ΔTR) with values falling in the lower two tertiles of the study population (ΔTR<1.1%).Conclusion. Exercise increased the reactive hyperemic response to ischemia. This dynamic response was blunted in patients with cardiac risk factors. The usability of this short-term effect for the preoperative assessment of endothelial function warrants further study.

scholarly journals Preoperative assessment of cardiovascular risk in patients undergoing noncardiac surgery: the Orion study

2020 ◽  
Vol 90 (1) ◽  
Author(s):  
Giampaolo Scorcu ◽  
Annarita Pilleri ◽  
Paolo Contu ◽  
Pompilio Faggiano ◽  
Roberto Floris ◽  
...  
Keyword(s):  
Risk Score ◽  
Risk Index ◽  
Preoperative Assessment ◽  
Predictive Performance ◽  
Roc Curves ◽  
Cardiac Risk ◽  
Cardiovascular Complications ◽  
Noncardiac Surgery ◽  
Derivation Cohort ◽  
Risk Indices

In patients undergoing noncardiac surgery risk indices can estimate patients’ perioperative risk of major cardiovascular complications. The indexes currently in use were derived from observational studies that are now outdated with respect to the current clinical context. We undertook a prospective, observational, cohort study to derive, validate, and compare a new risk index with established risk indices. We evaluated 7335 patients (mean age 63±13 years) who underwent noncardiac surgery. Based on prospective data analysis of 4600 patients (derivation cohort) we developed an Updated Cardiac Risk Score (UCRS), and validated the risk score on 2735 patients (validation cohort). Four variables (i.e. the UCRS) were significantly associated with the risk of a major perioperative cardiovascular events: high-risk surgery, preoperative estimate glomerular filtration rate <30 ml/min/1.73 m2, age ≥75 years, and history of heart failure. Based on the UCRS we created risk classes 1,2,3 and 4 and their corresponding 30-day risk of a major cardiovascular complication was 0.8% [95% confidence interval (CI) 0.5-1.7], 2.5 (95% CI 1.6-5.6), 8.7 (95% CI 5.2-18.9) and 27.2 (95% CI 11.8-50.3), respectively. No significant differences were found between the derivation and validation cohorts. Receiver operating characteristic (ROC) curves demonstrate a high predictive performance of the new index, with greater power to discriminate between the various classes of risk than the indexes currently used. The high predictive performance and simplicity of the UCRS make it suitable for wide-scale use in preoperative cardiac risk assessment of patients undergoing noncardiac surgery.

Prediction of Cardiac Risk prior to Elective Abdominal Aortic Surgery: Role of Multiple Gated Acquisition Scan

2003 ◽  
Vol 27 (10) ◽  
pp. 1085-1092 ◽  
Author(s):  
Christos D. Karkos ◽  
George J.L. Thomson ◽  
Robert Hughes ◽  
Miland Joshi ◽  
Mohamed S. Baguneid ◽  
...  
Keyword(s):  
Aortic Surgery ◽  
Cardiac Risk ◽  
Abdominal Aortic Surgery ◽  
Abdominal Aortic ◽  
Gated Acquisition

Preoperative assessment of cardiac risk in noncardiac major vascular surgery

1999 ◽  
Vol 83 (2) ◽  
pp. 169-174 ◽  
Author(s):  
Alberto Roghi ◽  
Bruno Palmieri ◽  
Wilma Crivellaro ◽  
Roberto Sara ◽  
Maurizio Puttini ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Preoperative Assessment ◽  
Cardiac Risk ◽  
Major Vascular Surgery

Combining Clinical and Thallium Data Optimizes Preoperative Assessment of Cardiac Risk Before Major Vascular Surgery

1990 ◽  
Vol 34 (3) ◽  
pp. 158
Author(s):  
K. A. EAGLE ◽  
C. M. COLEY ◽  
J. B. NEWELL ◽  
D. C. BREWSTER ◽  
C. DARLING ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Preoperative Assessment ◽  
Cardiac Risk ◽  
Major Vascular Surgery

Cardiac safety in patients (pts) with metastatic breast cancer (MBC) treated with lapatinib (L) and trastuzumab (TRA)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 514-514 ◽  
Author(s):  
A. M. Storniolo ◽  
M. Koehler ◽  
A. Preston ◽  
E. Rappold ◽  
J. Byrne ◽  
...  
Keyword(s):  
Kinase Inhibitors ◽  
Systolic Dysfunction ◽  
Metastatic Breast ◽  
Cardiac Risk ◽  
Cardiac Monitoring ◽  
Cardiac Events ◽  
Her2 Positive ◽  
Gated Acquisition ◽  
Grade 3 ◽  
Time To Onset

514 Background: Clearly defined standards for assessing cardiac toxicity do not exist for newer agents used as treatment for BC, e.g., tyrosine kinase inhibitors. To evaluate the usefulness of increased cardiac monitoring and cardiac function (LVEF) in pts treated with L+TRA, data from 4 trials were analyzed. Methods: From July 2003 to Dec 2006, 238 pts received L+TRA (n=203) or L+TRA with paclitaxel or docetaxel (n=35) for HER2-positive MBC. LVEF was evaluated at screening, every 8 weeks after starting L+TRA, and at withdrawal via multiple-gated acquisition scans or echocardiograms. Rate of symptomatic cardiac events (CE; NCI CTCAE Grade 3 or 4 LV systolic dysfunction) or asymptomatic LVEF decreases (=20% relative to baseline and below the institution’s lower limit of normal) were assessed. Results: None of the 238 pts had a symptomatic CE. Four pts had a single asymptomatic LVEF decrease and 1 pt had 2 asymptomatic LVEF decreases, totaling 6 decreases in 5 (2.1%) pts. These pts were women aged 36–64 years and had previously received anthracyclines (A; n=2), A+TRA (n=2), or unknown therapy (n=1). Median time to onset of LVEF decrease was 83 days; all but 1 decrease occurred within 75 days after initiating L+TRA (range: 18–221 days). Baseline LVEFs of 62%, 60%, 62%, 74% and 58% decreased to 47%, 46%, 45%, 45%, and 45%, respectively. L+TRA was temporarily interrupted in 3 pts and continued in 2 pts despite LVEF decrease. Per investigators, LVEF decrease resolved with no further sequelae in 4 pts (59%, 56%, 60%, and 50%) and was ongoing in 1 pt. Conclusion: Initial data indicate L+TRA or L+TRA with taxanes does not constitute a serious incremental cardiac risk and may not require more stringent cardiac monitoring than is used for A or TRA alone. The combined effect of HER2 inhibition with L+TRA appears not to increase the risk of CE in this population. No significant financial relationships to disclose.

Surgical Management of Patients With 22q11.2 Deletion Syndrome

2019 ◽  
Vol 4 (5) ◽  
pp. 857-869
Author(s):  
Oksana A. Jackson ◽  
Alison E. Kaye
Keyword(s):  
Surgical Management ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
22Q11.2 Deletion Syndrome ◽  
Deletion Syndrome ◽  
22Q11.2 Deletion ◽  
Surgical Decision ◽  
Obstructive Sleep ◽  
Spine Abnormalities ◽  
Speech Assessment

Purpose The purpose of this tutorial was to describe the surgical management of palate-related abnormalities associated with 22q11.2 deletion syndrome. Craniofacial differences in 22q11.2 deletion syndrome may include overt or occult clefting of the palate and/or lip along with oropharyngeal variances that may lead to velopharyngeal dysfunction. This chapter will describe these circumstances, including incidence, diagnosis, and indications for surgical intervention. Speech assessment and imaging of the velopharyngeal system will be discussed as it relates to preoperative evaluation and surgical decision making. Important for patients with 22q11.2 deletion syndrome is appropriate preoperative screening to assess for internal carotid artery positioning, cervical spine abnormalities, and obstructive sleep apnea. Timing of surgery as well as different techniques, common complications, and outcomes will also be discussed. Conclusion Management of velopharyngeal dysfunction in patients with 22q11.2 deletion syndrome is challenging and requires thoughtful preoperative assessment and planning as well as a careful surgical technique.

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