The optimal model of cardiac tests in patients with initial cardiac pathology before interventions for cancer of the esophagus, stomach, and pancreatic cancer
Abstract
Prior to planned operations it is extremely important to adequately assess the risk of the patient
according to an examination of the cardiovascular system. It is important not to perform the
study, the results of which will not affect significantly the stratification of perioperative risk.
The aim of the study was to determine the optimal amount of examination of the cardiovascular
system before a planned abdominal surgery in patients with initial cardiac pathology.
Material and methods. In the study were consecutively included 136 patients (median age –
67 years) underwent elective surgery for cancer of the esophagus, stomach and pancreas.
All patients had a history of ischemic heart disease and/or hypertensive disease of II–III stage.
We registered documented myocardial infarction, stroke or death from cardiovascular causes during and within 30 days after surgery. For all patients before the operation full range of cardiac examinations, including echocardiography with tissue Doppler and longitudinal strain estimation
of the myocardium and cardio-pulmonary stress test ergospirometry were performed.
Results. Of 136 included patients, 12 (7.5%) revealed various cardiovascular complications (CC):
6 non-fatal myocardial infarction (3.8%), 2 stroke (1.3%); 4 patients died from cardiovascular causes
(2.5%). An independent predictor of CC was the rate of increase in heart rate in the first minute of
the stress test (Protocol Mod-BRUCE) more than 25% (odds ratio of 4.6). The standard stress test significantly improves the predictive ability of the examination and should be performed before surgery
in the absence of contraindications. Additional recording parameters of spirometry during stress test
increases predictive value of models of preoperative examination. The highest predictive accuracy had
the model, including: base model, additional accounting stress test data and additional Echocardiography techniques (VTI in left ventricular output tract) – AUC up to 0.87, Sensitivity 78%, Specificity
79%. Also a high predictive value had a model which took into account the baseline survey and the data of standard stress test: AUC – 0.85, Sensitivity – 82%, Specificity – 75%.
Keywords:cardiac risk, noncardiac surgery, diagnostic methods, myocardial infarction, cancer
Clin. Experiment. Surg. Petrovsky J. 2017; 5 (4): 75–84.
DOI: 10.24411/2308-1198-2017-00011
Received: 30.03.2017. Accepted: 10.10.2017.
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