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Impact of left ventricular ejection fraction and preoperative hemoglobin level on perioperative adverse cardiovascular events in noncardiac surgery

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Abstract

The prediction of a perioperative adverse cardiovascular event (PACE) is an important clinical issue in the medical management of patients undergoing noncardiac surgery. Although several predictors have been reported, simpler and more practical predictors of PACE have been needed. The aim of this study was to investigate the predictors of PACE in noncardiac surgery. We retrospectively analyzed 723 patients who were scheduled for elective noncardiac surgery and underwent preoperative examinations including 12-lead electrocardiography, transthoracic echocardiography, and blood test. PACE was defined as cardiac death, non-fatal myocardial infarction, unstable angina, congestive heart failure, arrhythmia attack that needs emergency treatment (rapid atrial fibrillation, ventricular tachycardia, and bradycardia), acute pulmonary embolism, asystole, pulseless electrical activity, or stroke during 30 days after surgery. PACE occurred in 54 (7.5%) of 723 patients. High-risk operation (11% vs. 3%, p = 0.003) was more often seen, left ventricular ejection fraction (LVEF) (55 ± 8% vs. 60 ± 7%, p = 0.001) and preoperative hemoglobin level (11.8 ± 2.2 g/dl vs. 12.7 ± 2.0 g/dl, p = 0.001) were lower in patients with PACE compared to those without PACE. By multivariate logistic regression analysis, high-risk operation (odds ratio (OR): 7.05, 95% confidence interval (CI) 2.16–23.00, p = 0.001), LVEF (OR 1.06, every 1% decrement, 95% CI 1.03–1.09, p = 0.001), and preoperative hemoglobin level (OR 1.22, every 1 g/dl decrement, 95% CI 1.07–1.39, p = 0.003) were identified as independent predictors of PACE. Receiver operating characteristic analysis demonstrated that LVEF of 58% (sensitivity = 80%, specificity = 61%, area under the curve (AUC) = 0.723) and preoperative hemoglobin level of 12.2 g/dl (sensitivity = 63%, specificity = 64%, AUC = 0.644) were optimal cut-off values for predicting PACE. High-risk operation, reduced LVEF, and reduced preoperative hemoglobin level were independently associated with PACE in patients undergoing noncardiac surgery.

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Abbreviations

AUC:

Area under the curve

CI:

Confidence interval

CKD:

Chronic kidney disease

ECG:

Electrocardiography

eGFR:

Estimated of glomerular filtration rate

LVEF:

Left ventricular ejection fraction

OR:

Odds ratio

PACE:

Perioperative adverse cardiovascular event

RCRI:

Revised cardiac risk index

TDI:

Tissue Doppler imaging

TTE:

Transthoracic echocardiography

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan

    Hiromichi Sougawa, Yasushi Ino, Hironori Kitabata, Takashi Tanimoto, Masahiro Takahata, Kunihiro Shimamura, Yasutsugu Shiono, Tomoyuki Yamaguchi, Akio Kuroi, Shingo Ota, Akira Taruya, Kazushi Takemoto, Atsushi Tanaka, Takashi Kubo, Takeshi Hozumi & Takashi Akasaka

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  1. Hiromichi Sougawa
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Correspondence to Yasushi Ino.

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380_2021_1818_MOESM1_ESM.docx

Supplementary file1 Univariate and multivariate analysis for independent predictors of perioperative adverse cardiovascular event (male and female) (DOCX 16 KB)

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Sougawa, H., Ino, Y., Kitabata, H. et al. Impact of left ventricular ejection fraction and preoperative hemoglobin level on perioperative adverse cardiovascular events in noncardiac surgery. Heart Vessels 36, 1317–1326 (2021). https://doi.org/10.1007/s00380-021-01818-x

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