Prevalence and pharmacological treatment of left-ventricular dysfunction in patients undergoing vascular surgery

AimsThis study evaluated the prevalence of left-ventricular (LV) dysfunction in vascular surgery patients and pharmacological treatment, according ESC guidelines.Methods and resultsEchocardiography was performed pre-operatively in 1005 consecutive patients. Left ventricular ejection fraction (LVEF) ≤50 defined systolic LV dysfunction. Diastolic LV dysfunction was diagnosed based on E/A-ratio, pulmonary vein flow, and deceleration time. Optimal pharmacological treatment to improve LV function was considered as: (i) angiotensin-blocking agent (ACE-I/ARB) in patients with LVEF ≤40; (ii) ACE-I/ARB and-blocker in patients with LVEF ≤40 + heart failure symptoms or previous myocardial infarction; and (iii) a diuretic in patients with symptomatic heart failure, regardless of LVEF. Left-ventricular dysfunction was present in 506 patients (50), of whom 209 (41) had asymptomatic diastolic LV dysfunction, 194 (39) had asymptomatic systolic LV dysfunction, and 103 (20) had symptomatic heart failure. Treatment with ACE-I/ARB and/or-blocker could be initiated/improved in 67 (34) of the 199 patients with (a)symptomatic LVEF ≤40. A diuretic could be initiated in 32 patients (31) with symptomatic heart failure (regardless of LVEF).ConclusionsThis study demonstrates a high prevalence of LV dysfunction in vascular surgery patients and under-utilization of ESC recommended pharmacological treatment. Standard pre-operative evaluation of LV function could be argued based on our results to reduce this observed care gap.

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