Prognostic value of left ventricular global longitudinal strain for predicting postoperative myocardial infarction in patients with major non-cardiac surgery
- Conditions
- Diseases of the circulatory system
- Registration Number
- KCT0005147
- Lead Sponsor
- Yonsei University Yongin Severance Hospital
- Brief Summary
Background: The usefulness of preoperative measurement of left ventricular global longitudinal strain (LVGLS) for predicting prognosis in patients undergoing non-cardiac surgery has not been evaluated. We analyzed the prognostic value of LVGLS in predicting postoperative 30-day cardiovascular events and myocardial injury after non-cardiac surgery (MINS). Methods: This prospective cohort study was conducted in two referral hospitals and included 871 patients who underwent non-cardiac surgery <1 month after preoperative echocardiography. Those with ejection fraction <40%, valvular heart disease, and regional wall motion abnormality were excluded. The co-primary endpoints were the (1) composite incidence of all-cause death, acute coronary syndrome (ACS), and MINS and (2) composite incidence of all-cause death and ACS. Results: Among the 871 participants enrolled (mean age: 72.9 years; female: 60.8%), there were 43 cases of the primary endpoint (4.9%): 10 deaths, 3 ACS, and 37 MINS. Participants with impaired LVGLS (=16.6%) had a higher incidence of the co-primary endpoints (log-rank P < 0.001 and 0.015) than those without. The result was similar after adjustment with clinical variables and preoperative troponin T levels (hazard ratio = 1.30, 95% confidence interval [CI] = 1.03-1.65; P = 0.027). In sequential Cox analysis and net reclassification index, LVGLS had an incremental value for predicting the co-primary endpoints after non-cardiac surgery. Among the 538 (61.8%) participants who underwent serial troponin assay, LVGLS predicted MINS independently from the traditional risk factors (odds ratio = 3.54, 95% CI = 1.70-7.36; P = 0.001). Conclusions: Preoperative LVGLS has an independent and incremental prognostic value in predicting early postoperative cardiovascular events and MINS.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Completed
- Sex
- All
- Target Recruitment
- 871
1. The patient who has at least one cardiovascular risk factor among patients undergoing non-cardiac major surgery
(1) Non-cardiac major surgery
? Major orthopedic surgery
? Major General Surgery
? Major urology or gynecology surgery
? Major neurosurgery
? Major vascular surgery
? Major thoracic surgery
(2) Cardiovascular risk factors
? Age (over 65 years old)
? Coronary artery disease
? Peripheral artery disease
? History of stroke or transient ischemic accident
? Diabetes Mellitus
? Chronic kidney disease
? Heart failure
? Uncontrolled hypertension (Systolic blood pressure over 140 mmHg despite hypertension)
? Q wave, T inversion, or ST depression in electrocardiogram
2. Over 45-year old
3. Informed consent
(1) A person who is unable to understand the purpose and method of this clinical trial due to more than moderate degree of dementia, mental illness or neurological disease
(2) Low risk minor surgery
: ear/nose/throat surgery, ophthalmology, thyroid, parathyroid, breast, local anorectal procedure, breast, salpingectomy, endometrial ablation, peripheral nerve surgery, cosmetic surgery, hand surgery, arterio-venous access surgery for dialysis
(3) left ventricular ejection fraction below 40% on transthoracic echocardiography
(4) Regional wall motion abnormality on transthoracic echocardiography
(5) More than moderate degree of valvular heart disease on transthoracic echocardiography
(6) Left bundle branch block on electrocardiogram
(7) Atrial fibrillation on electrocardiogram
Study & Design
- Study Type
- Observational Study
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method The composite of all-cause mortality, aborted sudden cardiac death, congestive heart failure, coronary revascularization
- Secondary Outcome Measures
Name Time Method individual parameters of primary outcome, ischemic and hemorrhagic stroke