Prevalence and pharmacological treatment of left-ventricular dysfunction in patients undergoing vascular surgery.

Abstract

AIMS:

This study evaluated the prevalence of left-ventricular (LV) dysfunction in vascular surgery patients and pharmacological treatment, according ESC guidelines.

METHODS AND RESULTS:

Echocardiography was performed pre-operatively in 1,005 consecutive patients. Left ventricular ejection fraction (LVEF) <or=50% defined systolic LV dysfunction. Diastolic LV dysfunction was diagnosed based on E/A-ratio, pulmonary vein flow, and deceleration time. Optimal pharmacological treatment to improve LV function was considered as: (i) angiotensin-blocking agent (ACE-I/ARB) in patients with LVEF <or=40%; (ii) ACE-I/ARB and beta-blocker in patients with LVEF <or=40% + heart failure symptoms or previous myocardial infarction; and (iii) a diuretic in patients with symptomatic heart failure, regardless of LVEF. Left-ventricular dysfunction was present in 506 patients (50%), of whom 209 (41%) had asymptomatic diastolic LV dysfunction, 194 (39%) had asymptomatic systolic LV dysfunction, and 103 (20%) had symptomatic heart failure. Treatment with ACE-I/ARB and/or beta-blocker could be initiated/improved in 67 (34%) of the 199 patients with (a)symptomatic LVEF <or=40%. A diuretic could be initiated in 32 patients (31%) with symptomatic heart failure (regardless of LVEF).

CONCLUSIONS:

This study demonstrates a high prevalence of LV dysfunction in vascular surgery patients and under-utilization of ESC recommended pharmacological treatment. Standard pre-operative evaluation of LV function could be argued based on our results to reduce this observed care gap.

• Authors: Willem-Jan Flu, Jan-Peter van Kuijk, Wael Galal, Ruud Kuiper, Louis L van de Ven, Hence J M Verhagen, Jeroen J Bax, Don Poldermans
• Journal: European journal of heart failure (Eur J Heart Fail) Vol. 12 Issue 3 Pg. 288-93 (Mar 2010) ISSN: 1879-0844 [Electronic] England
• PMID: 20097682 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenergic beta-Antagonists
• Angiotensin II Type 1 Receptor Blockers
• Angiotensin-Converting Enzyme Inhibitors
• Antihypertensive Agents

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Aged
• Analysis of Variance
• Angiotensin II Type 1 Receptor Blockers (therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Antihypertensive Agents (therapeutic use)
• Confidence Intervals
• Echocardiography
• Female
• Humans
• Male
• Multivariate Analysis
• Netherlands (epidemiology)
• Practice Guidelines as Topic
• Preoperative Care
• Prevalence
• Proportional Hazards Models
• Risk Factors
• Stroke Volume
• Surveys and Questionnaires
• Vascular Surgical Procedures
• Ventricular Dysfunction, Left (diagnostic imaging, drug therapy, epidemiology)
• Ventricular Function, Left