Dobutamine-atropine stress echocardiography : a method for preoperative cardiac risk stratification in patients undergoing major vascular surgery

Atherosclerosis is a systemic disease that may affect several blood vessels in different organs simultaneously. The spectrum of disease ranges from stroke to myocardial infarction, aortic aneurysms and peripheral vascular insufficiency. Patients suffering from one aspect of atherosclerotic disease will often have asymptomatic lesions elsewhere. Most patients seen with vascular disease by the internist or surgeon have a high prevalence of coronary artery disease, for example, 40-70% of patients undergoing major vascular surgery without clinically evident coronary artery disease will indeed have angiographically demonstrable coronary artery stenosisl . The coronary artery disease may be dormant due to lack of exercise but will undoubtedly have an impact on the management of patients. In patients undergoing vascular surgery coronary artery disease contributes to both perioperative and late death. The number of patients with vascular disease and concomitant coronary artery disease is increasing as the prevalence of cardiovascular diseases increases with age, and the population of Europe is aging rapidly. The number of people over 60 years of age in Europe will probably increase with more than 92 million to 224 million in the year 20252 • Conventional testing in patients with vascular disease for coronary artery disease by exercise stress tests is often impossible due to noncardiac disease. Most patients are suffering from claudication or neurological disease

Prognosis of Transient New-Onset Atrial Fibrillation During Vascular Surgery

AbstractBackgroundChronic atrial fibrillation (AF) in a non-surgical setting is associated with cardiovascular events. However, the prognosis of transient new-onset AF during vascular surgery is unknown.ObjectiveThe purpose of this study is to investigate the prognosis of new-onset AF during vascular surgery using continuous electrocardiographic monitoring (continuous-ECG).MethodsIn this study, 317 patients, all in sinus rhythm, scheduled for major vascular surgery were screened for cardiac risk factors. Continuous-ECG recordings for 72h and standard ECG on days 3, 7 and 30 were used to identify new-onset AF. Cardiac troponin T (cTnT) was measured routinely after surgery. Study endpoint was a composite of cardiac death, myocardial infarction, unstable angina and stroke (cardiovascular events) at 30 days after surgery and during late follow-up. Median follow-up was 12 (interquartile range 2–28) months.ResultsNew-onset AF was noted in 15 (4.7%) patients. All but three patients returned spontaneously to sinus rhythm. The composite endpoint of cardiovascular events within 30 days and during late follow-up occurred in 34 (11%) and 62 (20%) patients, respectively. Multivariate regression analysis showed that new-onset AF was associated with perioperative (hazard ratio (HR) 6.0; 95% CI: 2.4–15) and late cardiovascular events (HR 4.2, 95% CI: 2.1–8.8).ConclusionNew-onset AF during vascular surgery is associated with an increased incidence of 30-day and late cardiovascular events