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.
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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)
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Chemical References |
- Adrenergic beta-Antagonists
- Angiotensin II Type 1 Receptor Blockers
- Angiotensin-Converting Enzyme Inhibitors
- Antihypertensive Agents
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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
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