Preoperative Evaluation of Cardiac Failure and Ischemia in Elderly Patients by Cardiopulmonary Exercise Testing
Major surgery in the elderly continues to have a high mortality rate. Preoperative myocardial ischemia is a known risk factor. Cardiac failure is also a risk factor, but is difficult to quantify objectively. One hundred eighty-seven elderly surgical patients were evaluated for cardiac failure by car...
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| Veröffentlicht in: | Chest 1993-09, Vol.104 (3), p.701-704 |
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| creator | Older, Raul Smith, Robert Courtney, Beter Hone, Rodney |
| description | Major surgery in the elderly continues to have a high mortality rate. Preoperative myocardial ischemia is a known risk factor. Cardiac failure is also a risk factor, but is difficult to quantify objectively. One hundred eighty-seven elderly surgical patients were evaluated for cardiac failure by cardiopulmonary exercise testing (CPX). The overall mortality in these patients was 7.5 percent. If three deaths secondary to surgical causes are excluded, mortality was 5.9 percent. There were 55 patients in whom the anaerobic threshold (AT) was less than 11 ml/min/kg; of these, 10 died, a mortality rate of 18 percent. There were 132 patients with an AT of greater than 11 ml/min/kg and of these, 1 patient died, giving a mortality rate of 0.8 percent (p |
| doi_str_mv | 10.1378/chest.104.3.701 |
| format | Article |
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Preoperative myocardial ischemia is a known risk factor. Cardiac failure is also a risk factor, but is difficult to quantify objectively. One hundred eighty-seven elderly surgical patients were evaluated for cardiac failure by cardiopulmonary exercise testing (CPX). The overall mortality in these patients was 7.5 percent. If three deaths secondary to surgical causes are excluded, mortality was 5.9 percent. There were 55 patients in whom the anaerobic threshold (AT) was less than 11 ml/min/kg; of these, 10 died, a mortality rate of 18 percent. There were 132 patients with an AT of greater than 11 ml/min/kg and of these, 1 patient died, giving a mortality rate of 0.8 percent (p<0.001). A low AT associated with preoperative ischemia resulted in the death of 8 of 19 patients, a mortality rate of 42 percent. When the ischemia was associated with the higher AT, then 1 patient out of 25 died, a mortality rate of 4 percent (p<0.01). Both preoperative ischemia and preoperative cardiac failure are independent risk factors for perioperative mortality in the elderly.</description><identifier>ISSN: 0012-3692</identifier><identifier>EISSN: 1931-3543</identifier><identifier>DOI: 10.1378/chest.104.3.701</identifier><identifier>PMID: 8365279</identifier><identifier>CODEN: CHETBF</identifier><language>eng</language><publisher>Northbrook, IL: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Anaerobic Threshold ; Biological and medical sciences ; Cardiac Output, Low - diagnosis ; Cardiovascular Diseases - mortality ; Cardiovascular system ; Exercise Test ; Female ; Humans ; Investigative techniques of hemodynamics ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Middle Aged ; Myocardial Ischemia - diagnosis ; Oxygen Consumption ; Postoperative Complications - mortality ; Preoperative Care ; Surgical Procedures, Operative - mortality</subject><ispartof>Chest, 1993-09, Vol.104 (3), p.701-704</ispartof><rights>1993 The American College of Chest Physicians</rights><rights>1994 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c477t-177bbf51a4ab3203eb3678cf0ee3ee1c5b2a1a46999cd40de4d4757926e425603</citedby><cites>FETCH-LOGICAL-c477t-177bbf51a4ab3203eb3678cf0ee3ee1c5b2a1a46999cd40de4d4757926e425603</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3780012$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8365279$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Older, Raul</creatorcontrib><creatorcontrib>Smith, Robert</creatorcontrib><creatorcontrib>Courtney, Beter</creatorcontrib><creatorcontrib>Hone, Rodney</creatorcontrib><title>Preoperative Evaluation of Cardiac Failure and Ischemia in Elderly Patients by Cardiopulmonary Exercise Testing</title><title>Chest</title><addtitle>Chest</addtitle><description>Major surgery in the elderly continues to have a high mortality rate. Preoperative myocardial ischemia is a known risk factor. Cardiac failure is also a risk factor, but is difficult to quantify objectively. One hundred eighty-seven elderly surgical patients were evaluated for cardiac failure by cardiopulmonary exercise testing (CPX). The overall mortality in these patients was 7.5 percent. If three deaths secondary to surgical causes are excluded, mortality was 5.9 percent. There were 55 patients in whom the anaerobic threshold (AT) was less than 11 ml/min/kg; of these, 10 died, a mortality rate of 18 percent. There were 132 patients with an AT of greater than 11 ml/min/kg and of these, 1 patient died, giving a mortality rate of 0.8 percent (p<0.001). A low AT associated with preoperative ischemia resulted in the death of 8 of 19 patients, a mortality rate of 42 percent. When the ischemia was associated with the higher AT, then 1 patient out of 25 died, a mortality rate of 4 percent (p<0.01). Both preoperative ischemia and preoperative cardiac failure are independent risk factors for perioperative mortality in the elderly.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anaerobic Threshold</subject><subject>Biological and medical sciences</subject><subject>Cardiac Output, Low - diagnosis</subject><subject>Cardiovascular Diseases - mortality</subject><subject>Cardiovascular system</subject><subject>Exercise Test</subject><subject>Female</subject><subject>Humans</subject><subject>Investigative techniques of hemodynamics</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Ischemia - diagnosis</subject><subject>Oxygen Consumption</subject><subject>Postoperative Complications - mortality</subject><subject>Preoperative Care</subject><subject>Surgical Procedures, Operative - mortality</subject><issn>0012-3692</issn><issn>1931-3543</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1993</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc9v0zAUxy0EGmVw5oTkA-KWzo6duD6iqoNJk9hhnC3HeVk9OXaxk0L_e95INbhwsq33_fH0MSHvOVtzoTZXbg9lWnMm12KtGH9BVlwLXolGipdkxRivK9Hq-jV5U8ojwzfX7QW52Ii2qZVekXSXIR0g28kfge6ONsx4TZGmgW5t7r119Nr6MGegNvb0pmDj6C31ke5CDzmc6B06IE6FdqfFkw5zGFO0-UR3vyA7X4De454-PrwlrwYbCrw7n5fk-_Xufvu1uv325Wb7-bZyUqmp4kp13dBwK20naiagE63auIEBCADumq62OGy11q6XrAfZS9UoXbcg66Zl4pJ8WnIPOf2YsduMvjgIwUZIczGq0VIwJlF4tQhdTqVkGMwh-xFXN5yZJ8TmD2J8SSMMIkbHh3P03I3QP-vPTHH-8Ty3xdkwZBuRwLMMI5--5W_x3j_sf_oMpow2BAwVS-VjmnO04d9ivTgAwR09ZFMcgnfQo9tNpk_-v0v_Bh4GqsQ</recordid><startdate>19930901</startdate><enddate>19930901</enddate><creator>Older, Raul</creator><creator>Smith, Robert</creator><creator>Courtney, Beter</creator><creator>Hone, Rodney</creator><general>Elsevier Inc</general><general>American College of Chest Physicians</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19930901</creationdate><title>Preoperative Evaluation of Cardiac Failure and Ischemia in Elderly Patients by Cardiopulmonary Exercise Testing</title><author>Older, Raul ; Smith, Robert ; Courtney, Beter ; Hone, Rodney</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c477t-177bbf51a4ab3203eb3678cf0ee3ee1c5b2a1a46999cd40de4d4757926e425603</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1993</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anaerobic Threshold</topic><topic>Biological and medical sciences</topic><topic>Cardiac Output, Low - diagnosis</topic><topic>Cardiovascular Diseases - mortality</topic><topic>Cardiovascular system</topic><topic>Exercise Test</topic><topic>Female</topic><topic>Humans</topic><topic>Investigative techniques of hemodynamics</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Ischemia - diagnosis</topic><topic>Oxygen Consumption</topic><topic>Postoperative Complications - mortality</topic><topic>Preoperative Care</topic><topic>Surgical Procedures, Operative - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Older, Raul</creatorcontrib><creatorcontrib>Smith, Robert</creatorcontrib><creatorcontrib>Courtney, Beter</creatorcontrib><creatorcontrib>Hone, Rodney</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Chest</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Older, Raul</au><au>Smith, Robert</au><au>Courtney, Beter</au><au>Hone, Rodney</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preoperative Evaluation of Cardiac Failure and Ischemia in Elderly Patients by Cardiopulmonary Exercise Testing</atitle><jtitle>Chest</jtitle><addtitle>Chest</addtitle><date>1993-09-01</date><risdate>1993</risdate><volume>104</volume><issue>3</issue><spage>701</spage><epage>704</epage><pages>701-704</pages><issn>0012-3692</issn><eissn>1931-3543</eissn><coden>CHETBF</coden><abstract>Major surgery in the elderly continues to have a high mortality rate. Preoperative myocardial ischemia is a known risk factor. Cardiac failure is also a risk factor, but is difficult to quantify objectively. One hundred eighty-seven elderly surgical patients were evaluated for cardiac failure by cardiopulmonary exercise testing (CPX). The overall mortality in these patients was 7.5 percent. If three deaths secondary to surgical causes are excluded, mortality was 5.9 percent. There were 55 patients in whom the anaerobic threshold (AT) was less than 11 ml/min/kg; of these, 10 died, a mortality rate of 18 percent. There were 132 patients with an AT of greater than 11 ml/min/kg and of these, 1 patient died, giving a mortality rate of 0.8 percent (p<0.001). A low AT associated with preoperative ischemia resulted in the death of 8 of 19 patients, a mortality rate of 42 percent. When the ischemia was associated with the higher AT, then 1 patient out of 25 died, a mortality rate of 4 percent (p<0.01). Both preoperative ischemia and preoperative cardiac failure are independent risk factors for perioperative mortality in the elderly.</abstract><cop>Northbrook, IL</cop><pub>Elsevier Inc</pub><pmid>8365279</pmid><doi>10.1378/chest.104.3.701</doi><tpages>4</tpages></addata></record> |
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| ispartof | Chest, 1993-09, Vol.104 (3), p.701-704 |
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| subjects | Aged Aged, 80 and over Anaerobic Threshold Biological and medical sciences Cardiac Output, Low - diagnosis Cardiovascular Diseases - mortality Cardiovascular system Exercise Test Female Humans Investigative techniques of hemodynamics Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Middle Aged Myocardial Ischemia - diagnosis Oxygen Consumption Postoperative Complications - mortality Preoperative Care Surgical Procedures, Operative - mortality |
| title | Preoperative Evaluation of Cardiac Failure and Ischemia in Elderly Patients by Cardiopulmonary Exercise Testing |
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