Preoperative Right Ventricular Echocardiographic Parameters Predict Perioperative Cardiovascular Complications in Patients Undergoing High risk Non-Cardiac Surgery

Abstract

Background : Every year, 200 million people worldwide undergo major noncardiac surgery (NCS), and 10 million people experience a signi fi cant cardiac problem during the fi rst 30 days following NCS. Perioperative cardiovascular complications (PCCs) are extremely signi fi cant as they contribute to at least one-third of perioperative mortality, lengthen hospital stays, and raise medical expenses. Objective : The aim was to investigate the importance of presurgical right ventricular (RV) echocardiographic parameters in the prediction of PCCs in individuals having high-risk NCS. Patients and methods : In this prospective cohort observational trial, 200 patients who were all potential candidates for high-risk, noncardiac operations between October 2020 and June 2021 were included. Patients were allocated preoperatively into one group and postoperatively into two groups according to the presence of postoperative cardiac complications. Results : The incidence of PPCs among the study population was about 36 patients of 200 patients with percentage of 18%. The results also revealed that signi fi cant predictors of postoperative PCCs after major NCS arranged by descending manner according to their odds ratio are as follows: Tie index greater than 0.47, tricuspid valve E/A (TV E/A) less than or equal to 1.18, tricuspid annular plane systolic excursion less than or equal to 1.8, MV E/A less than or equal to 1.3, left ventricular ejection fraction (LVEF) (%) less than or equal to 56, LVESDV (ml 3 ) greater than 35.6, HbA1C greater than 7.7, MV E/e ′ greater than 8.32, revised cardiac risk index, RV fractional area change (%) less than or equal to 35.6, mitral regurgitation (MR) up to moderate, serum creatinine (mg/dl) greater than 1.4, left atrial volume index (LAVI) greater than 22, and serum urea (mg/dl) greater than 34. By multivariate analysis, the authors found that the signi fi cant risk factors for PCCs are LVEF (%) less than or equal to 56, TV E/A less than or equal to 1.18, and Tie index greater than 0.47. Conclusion : RV echocardiographic measures taken before surgery are independent risk factors for PCCs in individuals having major NCS.