Preoperative echocardiographic predictors for 1-year mortality in patients treated with standard endovascular aneurysm repair for abdominal aortic aneurysm


Background: Abdominal aortic aneurysm (AAA) and cardiovascular disease are intimately associated, the latter representing the most common cause of death in Sweden. Cardiac complications are held responsible for the majority of perioperative morbidity and mortality in patients undergoing repair of AAA. The importance of preoperative thorough cardiac assessment is therefore obvious. The aim of this study was to evaluate the prognostic significance of preoperative echocardiographic findings for 1-year mortality after elective endovascular aneurysm repair (EVAR) of infrarenal AAA. Design: Retrospective analysis. Methods: The 505 patients were identified in a prospective database for endovascular interventions between 1998 and 2011, and data were retrieved from patient records. Preoperative echocardiography reports in 380 patients were reviewed and findings were notified according to a predefined protocol. Results: The 1-year mortality rate was 6.7%. Severe valve disease was present in 8.7% of the patients, aortic valve stenosis being the leading cause of valve pathology. Severe valve disease (OR 3.5, 95% CI [1.2 - 10.7]; p = 0.025) and chronic kidney disease grade ≥ 3 (OR 7.5, 95% CI [2.1 - 26.1]; p = 0.002) were the only independent risk factors for increased mortality rate at 1-year. Conclusion: Echocardiography should be a part of the preoperative workup in AAA patients. Finding of severe valve disease should be further evaluated by a cardiologist prior to EVAR.

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Ohrlander, T. , Dencker, M. and Acosta, S. (2013) Preoperative echocardiographic predictors for 1-year mortality in patients treated with standard endovascular aneurysm repair for abdominal aortic aneurysm. World Journal of Cardiovascular Diseases, 3, 268-274. doi: 10.4236/wjcd.2013.33043.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Dödsorsaker 2010.
[2] Van der Graaf, Y. (2008) Aggressive vascular surgery in asymptomatic patients is a bad idea. British Journal of Surgery, 95, 671-673. doi:10.1002/bjs.6233
[3] Earnshaw, J.J. (2011) Doubts and dilemmas over abdominal aortic aneurysm. British Journal of Surgery, 5, 607-608. doi:10.1002/bjs.7495
[4] Troisi, N., Dorigo, W., Lo Sapio, P., Pratesi, G., Pulli, R., Gensini, G.F., et al. (2010) Preoperative cardiac assessment in patients undergoing aortic surgery: Analysis of factors affecting outcomes. Annals of Vascular Surgery, 24, 733-740. doi:10.1016/j.avsg.2010.01.009
[5] Ohrlander, T., Dencker, M., Dias, N.V., Gottsäter, A. and Acosta, S. (2011) Cardiovascular predictors for long-term mortality after EVAR for AAA. Vascular Medicine, 16, 422-427. doi:10.1177/1358863X11425713
[6] MacFarlane, P.W. (2000) Minnesota coding and the prevalence of ECG abnormalities. Heart, 84, 582-584. doi:10.1136/heart.84.6.582
[7] De Bacquer, D., de Backer, G. and Kornitzer, M. (2000) Prevalences of ECG findings in large population based samples of men and women. Heart, 84, 625-633. doi:10.1136/heart.84.6.625
[8] Willenheimer, R., Erhardt, L. and Dahlöf, B. (1999) Simplified echocardiography: An accurate and inexpensive method for the assessment of left ventricular hypertrophy. European Heart Journal, 20, 1437-1438. doi:10.1053/euhj.1999.1656
[9] Gudmundsson, P., Rydberg, E., Winter, R. and Willenheimer, R. (2005) Visually estimated left ventricular ejection fraction by echocardiography is closely correlated with formal quantitative methods. International Journal of Cardiology, 101, 209-212. doi:10.1016/j.ijcard.2004.03.027
[10] Baumgartner, H., Hung, J., Bermejo, J., Chambers, J.B., Evangelista, A., Griffin, B.P., et al. (2009) EAE/ASE. Echocardiographic assessment of valve stenosis: EAE/ ASE recommendations for clinical practice. European Journal of Echocardiography, 10, 1-25. doi:10.1093/ejechocard/jen303
[11] Gottdiener, J.S., Panza, J.A., St John Sutton, M., Bannon, P., Kushner, H. and Weissman, N.J. (2002) Testing the test: The reliability of echocardiography in the sequential assessment of valvular regurgitation. American Heart Journal, 144, 115-121. doi:10.1067/mhj.2002.123139
[12] Cockcroft, D.W. and Gault, M.H. (1976) Prediction of creatinine clearance from serum creatinine. Nephron, 16, 31-41. doi:10.1159/000180580
[13] Abboud, H. and Henrich, W. (2010) Stage IV chronic kidney disease. The New England Journal of Medicine, 362, 56-65. doi:10.1056/NEJMcp0906797
[14] Quanjer, H., Tammeling, G.J., Coles, J.E., Pedersen, O.F., Peslin, R. and Yernault, J.-C. (1993) Lung volumes and forced ventilatory flows. Report working party. Standardization of Lung function tests. European community for steel and coal. Official statement of the European respiratory society. European Respiratory Journal, 6, 5-40.
[15] Berglund, E., Birath, G., Bjure, J. Grimby, G., Kjellmer, I. and Sandqvist, L., et al. (1963) Spirometric studies in normal subjects. I. Forced expirograms in subjects between 7 and 70 years of age. Acta Medica Scandinavica, 173, 185-192.
[16] Birath, G., Kjellmer, I. and Sandqvist, L. (1963) Spirometric studies in normal subjects. II. Ventilatory capacity tests in adults. Acta Medica Scandinavica, 173, 193-198.
[17] Grimby, G. and Soderholm, B. (1963) Spirometric studies in normal subjects. III Static lung volumes and maximum voluntary ventilation in adults with note on physical fitness. Acta Medica Scandinavica, 173, 199. doi:10.1111/j.0954-6820.1963.tb16523.x
[18] Pauwels, R.A., Buist, A.S., Calverley, P.M., Jenkins, C.R. and Hurd, S.S. (2001) Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD). Workshop summary. American Journal of Respiratory and Critical Care Medicine, 163, 1256-1276.
[19] Rohde, L., Polanczyk, C., Goldman, L., Cook, F., Lee, R. andLee, T. (2001) Usefulness of transthoracic echocardiography as a tool for risk stratification of patients undergoing major noncardiac surgery. American Journal of Cardiology, 87, 505-509. doi:10.1016/S0002-9149(00)01421-1
[20] Zahid, M., Sonel, A., Saba, S. and Good, C. (2005) Perioperative risk of non-cardiac surgery associated with aortic stenosis. American Journal of Cardiology, 96, 436438. doi:10.1016/j.amjcard.2005.03.095
[21] Kertai, M.D., Bountioukos, M., Boersma, E., Bax, J.J., Thomsaon, I.R., Sozz, F., et al. (2004) Aortic stenosis: An underestimated risk factor for perioperative complications in patients undergoing non-cardiac surgery. American Journal of Medicine, 116, 8-13. doi:10.1016/j.amjmed.2003.07.012
[22] Lee, F., Beckman, J., Brown, K., Calkins, H., Chaikof, E., Fleishmann, K., et al. (2007) ACC/AHA 2007 guideline on perioperative cardiovascular evaluation and care for noncardiac surgery: A report of the American College of Cardiology/American Heart Association Task Force on Practical Guidelines. Circulation, 116, e418-e500.
[23] Otto, C.M. (2006) Valvular stenosis: Disease severity and timing of intervention. Journal of the American College of Cardiology, 47, 2141-2151. doi:10.1016/j.jacc.2006.03.002
[24] Cuypers, P.W.K., Gardien, M., Buth, C., Peels, C.H., Charbon J.A. and Hop, W.C.J. (2001) Randomized study comparing cardiac response in endovascular and open abdominal aortic aneurysm repair. British Journal of Surgery, 88, 1059-1065. doi:10.1046/j.0007-1323.2001.01834.x
[25] Brown, L.C., Thompson, S.G., Greenhalgh, R.M. and Powell, J.T. (2011) Incidence of cardiovascular events and death after open or endovascular repair of abdominal aortic aneurysm in the randomized EVAR trial 1. British Journal of Surgery, 98, 935-942. doi:10.1002/bjs.7485
[26] Lederle, F., Freischlag, J., Kyriakides, T., Matsumura, J., Padberg, F., Kohler, T., et al. (2012) Long-term comparison of endovascular and open repair of abdominal aortic aneurysm. The New England Journal of Medicine, 367, 1988-1997. doi:10.1056/NEJMoa1207481
[27] Loxdale, S.J., Sneyd, J.R., Donovan, A., Werrett, G. and Viira, D.J. (2012) The role of routine pre-operative bedside echocardiography in detecting aortic stenosis in patients with a hip fracture. Anaesthesia, 67, 51-54. doi:10.1111/j.1365-2044.2011.06942.x
[28] Navas, E., McCalla-Lewis, A., Fernandez Jr., B., Pinski, S., Novaro, G. and Asher, C. (2012) Abdominal aortic aneurysm screening during transthoracic echocardiography: Cardiologist and vascular medicine specialist interpretation. World Journal of Cardiology, 26, 31-35. doi:10.4330/wjc.v4.i2.31
[29] Aboyans, V., Kownator, S., Lafitte, M., Brochet, E., Emmerich, J., Tribouilloy, C., et al. (2010) Screening abdominal aortic aneurysm during echocardiography: Literature review and proposal for a French nationwide study. Archives of Cardiovascular Disease, 103, 552-558.
[30] Spittell, P.C., Ehrsam, J.E., Andersson, L. and Seward, J.B. (1997) Screening for abdominal aortic aneurysm during transthoracic echocardiography in a hypertensive patient population. Journal of the American Society of Echocardiography, 10, 722-727. doi:10.1016/S0894-7317(97)70115-9

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