THE IMPORTANCE OF THE DIASTOLIC DYSFUNCTION IN THE CARDIOVASCULAR RISK STRATIFICATION OF NON-CARDIAC SURGICAL INTERVENTION

The article is an overview of foreign data on the evaluation of diastolic function disorders as a predictor of cardiovascular complications in non-cardiac surgical interventions. This problem is of significant practical interest, since in modern recommendations on the stratification of cardiac risk of perioperative complications, diastolic dysfunction is not identified as a negative prognostic factor. Although current guidelines on perioperative assessment of cardiovascular risks in extracardiac surgery do not evaluate diastolic dysfunction as a risk factor, more and more data indicate a higher incidence of serious adverse cardiac events, a longer hospital stay in patients with diastolic CHF. The article presents modern evidence supporting the need to include diastolic dysfunction in the risk stratification of non-cardiac surgical interventions.

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Biomarker-Based Preoperative Risk Stratification for Patients Undergoing Non-Cardiac Surgery

Journal of Clinical Medicine ◽

10.3390/jcm9020351 ◽

2020 ◽

Vol 9 (2) ◽

pp. 351 ◽

Cited By ~ 1

Author(s):

Timur Yurttas ◽

Reka Hidvegi ◽

Miodrag Filipovic

Keyword(s):

Cardiac Surgery ◽

Risk Stratification ◽

Treatment Strategies ◽

Cardiac Risk ◽

Cardiac Biomarkers ◽

Cardiac Events ◽

Perioperative Morbidity ◽

Substantial Problem ◽

Cardiovascular Assessment ◽

Patients At Risk

Perioperative morbidity and mortality remains a substantial problem and is strongly associated with patients’ cardiac comorbidities. Guidelines for the cardiovascular assessment and management of patients at risk of cardiac issues while undergoing non-cardiac surgery are traditionally based on the exclusion of active or unstable cardiac conditions, determination of the risk of surgery, the functional capacity of the patient, and the presence of cardiac risk factors. In the last two decades, strong evidence showed an association between cardiac biomarkers and adverse cardiac events, with newer guidelines incorporating this knowledge. This review describes a biomarker-based risk-stratification pathway and discusses potential treatment strategies for patients suffering from postoperative myocardial injury or infarction.

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Azithromycin and the Risk of Cardiovascular Complications

Journal of Pharmacy Practice ◽

10.1177/0897190013516503 ◽

2013 ◽

Vol 27 (5) ◽

pp. 496-500 ◽

Cited By ~ 22

Author(s):

Nicole M. Maisch ◽

Jenny G. Kochupurackal ◽

Jonathan Sin

Keyword(s):

Cohort Study ◽

Case Reports ◽

Torsades De Pointes ◽

Cardiac Risk ◽

Cardiovascular Death ◽

Cardiovascular Complications ◽

Qt Prolongation ◽

Baseline Risk ◽

Cardiac Events ◽

Increased Risk

The purpose of this review was to evaluate the literature to assess the incidence and true clinical relevance of recent Food and Drug Administration warnings regarding QT prolongation with azithromycin, given its widespread use, with over 40 million US outpatient prescriptions written in 2011. A literature search of MEDLINE (1946 to May 2013) and International Pharmaceutical Abstracts (1970 to May 2013) was conducted using the terms azithromycin, QT prolongation, torsades de pointes, arrhythmia, and cardiovascular death. A bibliographic search was also performed. Several relevant studies and case reports were identified and reviewed. One cohort study revealed an increased risk of cardiovascular death with azithromycin compared to no antibiotic, especially in those with higher cardiovascular risk. Another cohort study comparing azithromycin, penicillin V, and no antibiotic in a younger Danish population with less cardiac risk found no increased cardiovascular death associated with azithromycin use. The majority of case reports involved ill and/or elderly patients with multiple comorbidities and concomitant medications who were already at a higher risk of cardiovascular events. Although there is evidence that azithromycin may induce QT prolongation and adverse cardiac events, the incidence is fairly limited to patients with high baseline risk, including those with preexisting cardiovascular conditions and concomitant use of other QT-prolonging drugs.

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Postoperative atrial fibrillation as a risk factor for cardiovascular complications in non-cardiac surgery

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2020-2540 ◽

2020 ◽

Vol 19 (4) ◽

pp. 2540

Author(s):

O. N. Dzhioeva ◽

O. M. Drapkina

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Perioperative Complications ◽

Risk Index ◽

Clinical Importance ◽

Cardiac Risk ◽

Cardiovascular Complications ◽

Improvement Program ◽

Deliberate Hypotension ◽

Number Of Patients

Reducing mortality due to cardiovascular complications (CVC) after non-cardiac surgery is one of the priority tasks of modern healthcare. According to the literature data, it is the CVC that are leading cause of perioperative mortality in non-cardiac surgery. Atrial fibrillation (AF) is a common complication after surgery. It is believed that in most cases the AF is potentiated by a combination of factors. It is intraoperative triggers, such as deliberate hypotension, anemia, injury, and pain, that can directly contribute to development of arrhythmia. However, heart rate monitoring after non-cardiac surgery is performed in only a small number of patients, so in most cases, arrhythmias remain unreported. The Revised Cardiac Risk Index (RCRI) and theAmericanCollegeof Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator are the current tools for assessing perioperative cardiovascular risk. Postoperative AF is not included in any CVC risk stratification system. The presented review systematizes the data that postoperative AF is closely associated with perioperative complications and in some cases it may be the only marker of these complications. It has been shown that AF detection is of great clinical importance in both high-risk patients and, especially, in patients with a low risk of potential complications in non-cardiac surgery.

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Posthospital Cardiovascular Complications in Patients after Non-Cardiac Surgery

Messenger of Anesthesiology and Resuscitation ◽

10.21292/2078-5658-2021-18-4-62-72 ◽

2021 ◽

Vol 18 (4) ◽

pp. 62-72

Author(s):

D. A. Sokolov ◽

P. A. Lyuboshevsky ◽

I. N. Staroverov ◽

I. A. Kozlov

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Cardiac Surgery ◽

Chronic Heart Failure ◽

Cardiac Risk ◽

Cardiovascular Complications ◽

Cardiac Events ◽

Risk Indices ◽

Medium Risk ◽

Potential Risk Factors

The objective: to analyze the incidence and spectrum of cardiovascular complications within 12 months after noncardiac surgery, as well as to assess the association of preoperative values of various cardiac risk indices (CRI) and other potential risk factors with the actual development of complications.Subjects and Methods. We analyzed data of medical records and telephone interviews of 141 patients aged 65 [60-71] years who had undergone non-cardiac surgery a year before the interview The operations were low risk in 13.5% of observations, medium risk in 64.5%, and high risk in 22%. A retrospective calculation of the Revised CRI (RCRI), Individual CRI (Khoronenko CRI), and the American College of Surgeons Perioperative Risk for Myocardial Infarction or Cardiac Arrest (MICA) was performed.Results. Cardiac events (myocardial infarction, decompensation of chronic heart failure, new arrhythmias, stroke, and/or the need to prescribe or escalate the dose of cardiovascular drugs and/or hospitalization for cardiac indications, and/or death from cardiovascular diseases) within 12 months after elective noncardiac surgeries were detected in 27.7% of cases, and in 2.1% of patient's death occurred due to cardiac disorders. Predictors of cardiac events were concomitant ischemic heart disease (OR = 2.777; 95% CI 1.286-5.966; p = 0.0093) and chronic heart failure (OR = 2.900; 95% CI 1.224-6.869; p = 0, 0155), RCRI (OR = 1.886; 95% CI 1.2-8-2.944; p = 0.005), Khoronenko CRI (OR = 3254.3; 95% CI 64.33-164,638; p = 0.0001), MICA (OR = 1.628; 95% CI 1.156-2.292; p = 0.005), creatininemia on the first postoperative day (OR = 1.023; 95% CI 1.010-1.061; p = 0.005), and propensity for bradycardia during surgery (OR = 0.945; 95% CI 0.908-0.983; p = 0.005). Combined analysis of Khoronenko's CRI and postoperative creatininemia provided a very good model: area under the ROC-curve - 0.823 (95% CI 0.728-0.641; p = 0.0002).Conclusion. All studied CRIs can be used to predict posthospital cardiac events; however, the most promising is a joint assessment of Khoronenko's CRI and postoperative creatinemia.

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Association of abiraterone and higher odds of cardiac complications compared to enzalutamide.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.70 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 70-70 ◽

Cited By ~ 3

Author(s):

Eugene Blanchard Cone ◽

Stephen Reese ◽

Maya Marchese ◽

Junaid Nabi ◽

Kerry L. Kilbridge ◽

...

Keyword(s):

Prostate Cancer ◽

Standard Of Care ◽

Individual Case ◽

Cardiac Risk ◽

World Health ◽

Cardiac Complications ◽

Reporting Odds Ratio ◽

Cardiovascular Risks ◽

Cardiac Events ◽

Resistant Disease

70 Background: The standard of care for advanced prostate cancer is androgen deprivation therapy (ADT). The novel second generation agents abiraterone and enzalutamide were initially approved in castration resistant disease, but are now being used in the hormone sensitive setting. The FDA issued a 2010 warning about cardiovascular risks associated with ADT, but the risk of novel agents is less well understood, especially in comparison to each other. We sought to define the comparative cardiac risk profile of enzalutamide and abiraterone. Methods: We used VigiBase, the World Health Organization database of individual case safety reports, which collects data from more than 130 countries to identify drug associated adverse events (AE). Using Medical Dictionary for Regulatory Activities terminology, we identified cardiac AEs related to abiraterone or enzalutamide therapy for prostate cancer. To explore a possible relationship we used the reporting odds ratio (ROR), a surrogate measure of association using all other reactions as non-cases. A lower bound of a 95% confidence interval of ROR > 1 reflects a disproportionality signal that more AEs are observed than expected due to chance. Results: Vigibase contained 8203 AEs for abiraterone and 26024 for enzalutamide; 808 (9.9%) were cardiac-related for abiraterone, and 1000 for enzalutamide (3.8%). We found no disproportionality signal for cardiac events or any subtype for enzalutamide, but identified significantly higher odds of overall cardiac events (ROR 1.64, 95% CI 1.53—1.76), myocardial infarction (1.34, 1.17—1.58), arrythmia (2.09, 1.87—2.34), and heart failure (3.35, 2.92—3.85) for patients taking abiraterone. Conclusions: Using validated pharmacovigilance methodology, we found significantly increased odds of cardiac events for abiraterone but not for enzalutamide. Clinicians may need to consider these findings in the context of their patients’ comorbidities when prescribing ADT.

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Cardiovascular Risks Associated with Gender and Aging

Journal of Cardiovascular Development and Disease ◽

10.3390/jcdd6020019 ◽

2019 ◽

Vol 6 (2) ◽

pp. 19 ◽

Cited By ~ 23

Author(s):

Jennifer L. Rodgers ◽

Jarrod Jones ◽

Samuel I. Bolleddu ◽

Sahit Vanthenapalli ◽

Lydia E. Rodgers ◽

...

Keyword(s):

Cardiovascular Disease ◽

Risk Factor ◽

Elderly Population ◽

Hormone Replacement ◽

Cardiac Risk ◽

Cardiovascular Risks ◽

Cardiac Events ◽

Obesity And Diabetes ◽

And Gender ◽

Aging Adults

The aging and elderly population are particularly susceptible to cardiovascular disease. Age is an independent risk factor for cardiovascular disease (CVD) in adults, but these risks are compounded by additional factors, including frailty, obesity, and diabetes. These factors are known to complicate and enhance cardiac risk factors that are associated with the onset of advanced age. Sex is another potential risk factor in aging adults, given that older females are reported to be at a greater risk for CVD than age-matched men. However, in both men and women, the risks associated with CVD increase with age, and these correspond to an overall decline in sex hormones, primarily of estrogen and testosterone. Despite this, hormone replacement therapies are largely shown to not improve outcomes in older patients and may also increase the risks of cardiac events in older adults. This review discusses current findings regarding the impacts of age and gender on heart disease.

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How to asses and improve cardiopulmonary risk prior to vascular surgery?

VASA ◽

10.1024/0301-1526/a000297 ◽

2013 ◽

Vol 42 (5) ◽

pp. 323-330

Author(s):

Adrian Mahlmann ◽

Roman N. Rodionov ◽

Stefan Ludwig ◽

Julia Neidel ◽

Norbert Weiss

Keyword(s):

Perioperative Complications ◽

Scoring Systems ◽

Arterial Disease ◽

Cardiac Risk ◽

High Rate ◽

Surgical Interventions ◽

Perioperative Morbidity ◽

Quitting Smoking ◽

Patients At Risk ◽

Peripheral Arterial

Patients with peripheral arterial disease have a high rate of cardiac, cerebrovascular, or pulmonary comorbidities. Peripheral arterial surgical interventions are associated with a moderate to high perioperative cardiac risk. Simple clinical scoring systems for preoperative risk stratification can be used to identify high-risk patients. In these patients further diagnostic and therapeutic measures are required to reduce perioperative morbidity and mortality. In contrast, a group of patients can be identifed that do not require additional cardiopulmonary diagnostics and can immediately proceed to the intervention. According to evidence-based recommendations in patients at risk beta blocker should be uptitrated and statin therapy should be initiated preoperatively. Quitting smoking preoperatively also reduces perioperative complications and should be encouraged in all patients.

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