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Article ; Online: Cardiovascular-Kidney-Metabolic Syndrome: Association with Adverse Events After Major Noncardiac Surgery.

Roth, Sebastian / M'Pembele, René / Matute, Purificación / Kotfis, Katarzyna / Larmann, Jan / Lurati Buse, Giovanna

2024

Abstract: Background: The American Heart Association (AHA) recently defined the cardiovascular-kidney-metabolic syndrome (CKM) as a new entity to address the complex interactions between heart, kidneys, and metabolism. The aim of this study was to assess the ... ...

Abstract	Background: The American Heart Association (AHA) recently defined the cardiovascular-kidney-metabolic syndrome (CKM) as a new entity to address the complex interactions between heart, kidneys, and metabolism. The aim of this study was to assess the outcome impact of CKM syndrome in patients undergoing noncardiac surgery. Methods: This is a secondary analysis of a prospective international cohort study including patients aged ≥45 years with increased cardiovascular risk undergoing noncardiac surgery. Main exposure was CKM syndrome according to the AHA definition. The primary end point was a composite of major adverse cardiovascular events (MACE) 30 days after surgery. Secondary end points included all-cause mortality and non-MACE complications (Clavien-Dindo class ≥3). Results: This analysis included 14,634 patients (60.8% male, mean age = 72±8 years). MACE occurred in 308 patients (2.1%), and 335 patients (2.3%) died. MACE incidence by CKM stage was as follows: CKM 0: 5/367 = 1.4% (95% confidence interval [CI], 0.4%-3.2%); CKM 1: 3/367 = 0.8% (95% CI, 0.2%-2.4%); CKM 2: 102/7440 = 1.4% (95% CI, 1.1%-1.7%); CKM 3: 27/953 = 2.8% (95% CI, 1.9%-4.1%); CKM 4a: 164/5357 = 3.1% (95% CI, 2.6%-3.6%); CKM 4b: 7/150 = 4.7% (95% CI, 1.9%-9.4%). In multivariate logistic regression, CKM stage ≥3 was independently associated with MACE, mortality, and non-MACE complications, respectively (MACE: OR 2.26 [95% CI, 1.78-2.87]; mortality: OR 1.42 [95% CI: 1.13 -1.78]; non-MACE complications: OR 1.11 [95% CI: 1.03-1.20]). Conclusion: The newly defined CKM syndrome is associated with increased morbidity and mortality after non-cardiac surgery. Thus, cardiovascular, renal, and metabolic disorders should be regarded in mutual context in this setting.
Language	English
Publishing date	2024-04-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	80032-6
ISSN	1526-7598 ; 0003-2999
ISSN (online)	1526-7598
ISSN	0003-2999
DOI	10.1213/ANE.0000000000006975
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Article ; Online: Spontaneous Coronary Artery Dissection: Rediscovering an Old Cause of Myocardial Infarction.

Martinez, Samira / Giménez-Milà, Marc / Cepas, Pedro / Anduaga, Iñigo / Masotti, Monica / Matute, Purificación / Castellà, Manel / Sabaté, Manel

Journal of cardiothoracic and vascular anesthesia

2022 Volume 36, Issue 8 Pt B, Page(s) 3303–3311

Abstract: Spontaneous coronary artery dissection is an uncommon, but not insignificant cause of acute coronary syndrome that overwhelmingly affects middle-aged women. The pathophysiology of coronary dissection appears to be an outside-in mechanism, where the ... ...

Abstract	Spontaneous coronary artery dissection is an uncommon, but not insignificant cause of acute coronary syndrome that overwhelmingly affects middle-aged women. The pathophysiology of coronary dissection appears to be an outside-in mechanism, where the initiating event is not an intimal tear but rather the formation of an intramural hematoma, which compromises blood flow by reducing the arterial lumen. Considering this mechanism, it is clear to see how intracoronary imaging techniques, such as optical coherence tomography and intravascular ultrasound, are most accurate in the diagnosis. However, they carry a high rate of complications and are therefore generally avoided when the clinical scenario and angiographic appearance both support the diagnosis of spontaneous coronary artery dissection. The natural history of the disease is toward healing of the vessel wall and restoration of blood flow. Therefore, conservative medical management is the preferred approach unless there are high-risk factors such as hemodynamic instability, signs of ischemia and severe proximal or multivessel lesions, in which percutaneous or surgical revascularization should be considered. Perioperative evaluation of these patients must take into account several aspects of this disease. Most of these patients will be receiving single or dual antiplatelet therapy, so one must consider the timing of the event and the surgical hemorrhagic risk when deciding to stop these therapies. Extracoronary vascular disease also must be assessed because it can have an effect on patient monitoring and risk of postoperative complications.
MeSH term(s)	Coronary Angiography ; Coronary Vessel Anomalies/complications ; Coronary Vessel Anomalies/diagnostic imaging ; Coronary Vessels ; Female ; Humans ; Middle Aged ; Myocardial Infarction/complications ; Myocardial Infarction/etiology ; Vascular Diseases/complications ; Vascular Diseases/congenital ; Vascular Diseases/diagnostic imaging
Language	English
Publishing date	2022-03-24
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2022.03.022
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Article ; Online: Impact of cardiac surgery associated acute kidney injury on 1-year major adverse kidney events.

Molina Andújar, Alícia / Escudero, Victor Joaquin / Piñeiro, Gaston J / Lucas, Alvaro / Rovira, Irene / Matute, Purificación / Ibañez, Cristina / Blasco, Miquel / Quintana, Luis F / Sandoval, Elena / Sánchez, Marina Chorda / Quintana, Eduard / Poch, Esteban

Frontiers in nephrology

2023 Volume 3, Page(s) 1059668

Abstract: Background: The incidence of acute kidney injury following cardiac surgery (CSA-AKI) is up to 30%, and the risk of chronic kidney disease (CKD) has been found to be higher in these patients compared to the AKI-free population. The aim of our study was ... ...

Abstract	Background: The incidence of acute kidney injury following cardiac surgery (CSA-AKI) is up to 30%, and the risk of chronic kidney disease (CKD) has been found to be higher in these patients compared to the AKI-free population. The aim of our study was to assess the risk of major adverse kidney events (MAKE) [25% or greater decline in estimated glomerular filtration rate (eGFR), new hemodialysis, and death] after cardiac surgery in a Spanish cohort and to evaluate the utility of the score developed by Legouis D et al. (CSA-CKD score) in predicting the occurrence of MAKE. Methods: This was a single-center retrospective study of patients who required cardiac surgery with cardiopulmonary bypass (CPB) during 2015, with a 1-year follow-up after the intervention. The inclusion criteria were patients over 18 years old who had undergone cardiac surgery [i.e., valve substitution (VS), coronary artery bypass graft (CABG), or a combination of both procedures]. Results: The number of patients with CKD (eGFR < 60 mL/min) increased from 74 (18.3%) to 97 (24%) within 1 year after surgery. The median eGFR declined from 85 to 82 mL/min in the non-CSA-AKI patient group and from 73 to 65 mL/min in those with CSA-AKI ( Conclusion: Any-stage CSA-AKI is associated with a risk of MAKE after 1 year. Further research into new measures that identify at-risk patients is needed so that appropriate patient follow-up can be carried out.
Language	English
Publishing date	2023-04-24
Publishing country	Switzerland
Document type	Journal Article
ISSN	2813-0626
ISSN (online)	2813-0626
DOI	10.3389/fneph.2023.1059668
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Article ; Online: Pathological findings associated with the updated European Society of Cardiology 2022 guidelines for preoperative cardiac testing: an observational cohort modelling study.

Stroda, Alexandra / Mauermann, Eckhard / Ionescu, Daniela / Szczeklik, Wojciech / De Hert, Stefan / Filipovic, Miodrag / Beck Schimmer, Beatrice / Spadaro, Savino / Matute, Purificación / Ganter, Michael T / Ovezov, Alexey / Turhan, Sanem C / van Waes, Judith / Lagarto, Filipa / Theodoraki, Kassiani / Gupta, Anil / Gillmann, Hans-Jörg / Guzzetti, Luca / Kotfis, Katarzyna /

Larmann, Jan / Corneci, Dan / Buggy, Donal J / Howell, Simon J / Lurati Buse, Giovanna

British journal of anaesthesia

2024 Volume 132, Issue 4, Page(s) 675–684

Abstract: Background: In 2022, the European Society of Cardiology updated guidelines for preoperative evaluation. The aims of this study were to quantify: (1) the impact of the updated recommendations on the yield of pathological findings compared with the ... ...

Abstract	Background: In 2022, the European Society of Cardiology updated guidelines for preoperative evaluation. The aims of this study were to quantify: (1) the impact of the updated recommendations on the yield of pathological findings compared with the previous guidelines published in 2014; (2) the impact of preoperative B-type natriuretic peptide (NT-proBNP) use for risk estimation on the yield of pathological findings; and (3) the association between 2022 guideline adherence and outcomes. Methods: This was a secondary analysis of MET-REPAIR, an international, prospective observational cohort study (NCT03016936). Primary endpoints were reduced ejection fraction (EF<40%), stress-induced ischaemia, and major adverse cardiovascular events (MACE). The explanatory variables were class of recommendations for transthoracic echocardiography (TTE), stress imaging, and guideline adherence. We conducted second-order Monte Carlo simulations and multivariable regression. Results: In total, 15,529 patients (39% female, median age 72 [inter-quartile range: 67-78] yr) were included. The 2022 update changed the recommendation for preoperative TTE in 39.7% patients, and for preoperative stress imaging in 12.9% patients. The update resulted in missing 1 EF <40% every 3 fewer conducted TTE, and in 4 additional stress imaging per 1 additionally detected ischaemia events. For cardiac stress testing, four more investigations were performed for every 1 additionally detected ischaemia episodes. Use of NT-proBNP did not improve the yield of pathological findings. Multivariable regression analysis failed to find an association between adherence to the updated guidelines and MACE. Conclusions: The 2022 update for preoperative cardiac testing resulted in a relevant increase in tests receiving a stronger recommendation. The updated recommendations for TTE did not improve the yield of pathological cardiac testing.
MeSH term(s)	Humans ; Female ; Aged ; Male ; Prospective Studies ; Cardiology ; Echocardiography ; Natriuretic Peptide, Brain ; Peptide Fragments ; Ischemia ; Biomarkers
Chemical Substances	Natriuretic Peptide, Brain (114471-18-0) ; Peptide Fragments ; Biomarkers
Language	English
Publishing date	2024-02-09
Publishing country	England
Document type	Observational Study ; Journal Article
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1016/j.bja.2023.12.036
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Article: Assessment of Individualized Mean Perfusion Pressure Targets for the Prevention of Cardiac Surgery-Associated Acute Kidney Injury-The PrevHemAKI Randomized Controlled Trial.

Molina-Andujar, Alicia / Rios, José / Piñeiro, Gaston J / Sandoval, Elena / Ibañez, Cristina / Quintana, Eduard / Matute, Purificación / Andrea, Rut / Lopez-Sobrino, Teresa / Mercadal, Jordi / Reverter, Enric / Rovira, Irene / Villar, Ana Maria / Fernandez, Sara / Castellà, Manel / Poch, Esteban

Journal of clinical medicine

2023 Volume 12, Issue 24

Abstract: Background: Retrospective studies support that mean perfusion pressure (MPP) deficit in cardiac surgery patients is associated with a higher incidence of acute kidney injury (CS-AKI). The aim of our study was to apply an algorithm based on MPP in the ... ...

Abstract	Background: Retrospective studies support that mean perfusion pressure (MPP) deficit in cardiac surgery patients is associated with a higher incidence of acute kidney injury (CS-AKI). The aim of our study was to apply an algorithm based on MPP in the postoperative period to determine whether management with an individualized target reduces the incidence of CS-AKI. Methods: Randomized controlled trial of patients undergoing cardiac surgery with extracorporeal circulation. Adult patients submitted to valve replacement and/or bypass surgery with a high risk of CS-AKI evaluated by a Leicester score >30 were randomized to follow a target MPP of >75% of the calculated baseline or a standard hemodynamic management during the first postoperative 24 h. Results: Ninety-eight patients with an eGFR of 54 mL/min were included. There were no differences in MAP and MPP in the first 24 h between the randomized groups, although a higher use of noradrenaline was found in the intervention arm (38.78 vs. 63.27, Conclusion: An individualized hemodynamic management based on MPP compared to standard treatment in cardiac surgery patients was safe but did not reduce the incidence of CS-AKI in our study.
Language	English
Publishing date	2023-12-18
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12247746
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Article: Risk Factors for Acute Kidney Injury Following Cardiac Surgery and Performance of Leicester Score in a Spanish Cohort.

Molina Andújar, Alícia / Lucas, Alvaro / Escudero, Victor Joaquin / Rovira, Irene / Matute, Purificación / Ibañez, Cristina / Blasco, Miquel / Sandoval, Elena / Ruiz, Jesús / Chorda Sánchez, Marina / Piñeiro, Gaston J / Quintana, Eduard / Poch, Esteban

Journal of clinical medicine

2022 Volume 11, Issue 4

Abstract: The incidence of acute kidney injury following cardiac surgery (CSA-AKI) is up to 30%, and it places patients at an increased risk of death. The Leicester score (LS) is a new score that predicts CSA-AKI of any stage with better discrimination compared to ...

Abstract	The incidence of acute kidney injury following cardiac surgery (CSA-AKI) is up to 30%, and it places patients at an increased risk of death. The Leicester score (LS) is a new score that predicts CSA-AKI of any stage with better discrimination compared to previous scores. The aim of this study was to identify risk factors for CSA-AKI and to assess the performance of LS. A unicentric retrospective study of patients that required cardiac surgery with cardio-pulmonary bypass (CPB) in 2015 was performed. The inclusion criteria were patients over 18 years old who were operated on for cardiac surgery (valve substitution (VS), Coronary Artery Bypass Graft (CABG), or a combination of both procedures and requiring CPB). CSA-AKI was defined with the Kidney Disease Improving Global Outcomes (KDIGO) criteria. In the multivariate analysis, hypertension (odds ratio 1.883), estimated glomerular filtration rate (EGFR) <60 mL/min (2.365), and peripheral vascular disease (4.66) were associated with the outcome. Both discrimination and calibration were better when the LS was used compared to the Cleveland Clinic Score and Euroscore II, with an area under the curve (AUC) of 0.721. In conclusion, preoperative hypertension in patients with CKD with or without peripheral vasculopathy can identify patients who are at risk of CSA-AKI. The LS was proven to be a valid score that could be used to identify patients who are at risk and who could benefit from intervention studies.
Language	English
Publishing date	2022-02-09
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm11040904
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Article ; Online: Preoperative triage to detect SARS-CoV-2 infection in surgical patients: lessons learned for resuming surgery.

Pujol, Roger / Rivas, Eva / Gracia, Isabel / Caballero, Angel / Matute, Purificación / Cuñat, Tomas / Basora, Misericordia / Fábregas, Neus / Arguis, Maria José / Forne, Daniel Luis / Balibrea, José Maria / Besa, Anais / Laguna, Guillermo / Monsalve, Concepción / Lacy, Antonio M / Martinez-Pallí, Graciela

Surgery today

2022 Volume 53, Issue 6, Page(s) 709–717

Abstract: Purpose: To define the impact of the COVID-19 outbreak on hospital surgical activity and assess the incidence of perioperative COVID-19 within two protocolized screening pathways for elective and non-elective surgery.: Methods: We conducted a ... ...

Abstract	Purpose: To define the impact of the COVID-19 outbreak on hospital surgical activity and assess the incidence of perioperative COVID-19 within two protocolized screening pathways for elective and non-elective surgery. Methods: We conducted a prospective cohort study of adults undergoing surgery during the COVID-19 outbreak. The elective pathway included telephone surveys and a quantitative polymerase-chain-reaction test (RT-PCR) only for patients who were asymptomatic and at low risk of infection. Only patients with negative screening underwent surgery. In the non-elective pathway, preoperative screening was performed during the hospital admission. Results: Among 835 patients considered for the elective pathway, 725 had negative RT-PCR results and underwent surgery. This reflects an 83% reduction in surgical activity from 2019. Moreover, 596 patients underwent non-elective surgery, representing a 28% reduction. Preoperatively, 39 patients (6.5%) tested positive for SARS-CoV-2 and underwent surgery through the non-elective pathway, vs. none in the elective pathway (p < 0.001). Postoperatively, 1.4% of elective surgery patients and 2.2% of non-elective surgery patients tested positive (p > 0.05). Mortality was higher in non-elective surgery (0.6% vs. 2.9%, p < 0.001) and in patients with COVID-19 (0% vs. 14%, p < 0.001). Conclusions: The low incidence of COVID-19 in elective surgeries during the outbreak demonstrates the importance and effectiveness of preoperative screening, combining surveys and RT-PCR.
MeSH term(s)	Adult ; Humans ; COVID-19/diagnosis ; COVID-19/epidemiology ; SARS-CoV-2 ; Prospective Studies ; Triage ; Elective Surgical Procedures
Language	English
Publishing date	2022-10-21
Publishing country	Japan
Document type	Journal Article
ZDB-ID	1115435-4
ISSN	1436-2813 ; 0941-1291
ISSN (online)	1436-2813
ISSN	0941-1291
DOI	10.1007/s00595-022-02610-8
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Article ; Online: Erratum to 'Association between self-reported functional capacity and general postoperative complications: analysis of predefined outcomes of the MET-REPAIR international cohort study' (Br J Anaesth 2024; 132: 811-4).

Roth, Sebastian / M'Pembele, René / Nienhaus, Johannes / Mauermann, Eckhard / Ionescu, Daniela / Szczeklik, Wojciech / De Hert, Stefan / Filipovic, Miodrag / Beck-Schimmer, Beatrice / Spadaro, Savino / Matute, Purificación / Bolliger, Daniel / Turhan, Sanem C / van Waes, Judith / Lagarto, Filipa / Theodoraki, Kassiani / Gupta, Anil / Gillmann, Hans-Jörg / Guzzetti, Luca /

Kotfis, Katarzyna / Wulf, Hinnerk / Larmann, Jan / Corneci, Dan / Chammartin, Frédérique / Howell, Simon J / Buse, Giovanna L

British journal of anaesthesia

2024

Language	English
Publishing date	2024-03-23
Publishing country	England
Document type	Published Erratum
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1016/j.bja.2024.03.002
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Article ; Online: Association between self-reported functional capacity and general postoperative complications: analysis of predefined outcomes of the MET-REPAIR international cohort study.

Kotfis, Katarzyna / Wulf, Hinnerk / Larmann, Jan / Corneci, Dan / Chammartin, Frédérique / Howell, Simon J / Lurati Buse, Giovanna

British journal of anaesthesia

2024 Volume 132, Issue 4, Page(s) 811–814

MeSH term(s)	Humans ; Cohort Studies ; Self Report ; Postoperative Complications ; Prospective Studies ; Risk Factors
Language	English
Publishing date	2024-02-06
Publishing country	England
Document type	Letter
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1016/j.bja.2024.01.003
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Article ; Online: Risk assessment for major adverse cardiovascular events after noncardiac surgery using self-reported functional capacity: international prospective cohort study.

Lurati Buse, Giovanna A / Mauermann, Eckhard / Ionescu, Daniela / Szczeklik, Wojciech / De Hert, Stefan / Filipovic, Miodrag / Beck-Schimmer, Beatrice / Spadaro, Savino / Matute, Purificación / Bolliger, Daniel / Turhan, Sanem Cakar / van Waes, Judith / Lagarto, Filipa / Theodoraki, Kassiani / Gupta, Anil / Gillmann, Hans-Jörg / Guzzetti, Luca / Kotfis, Katarzyna / Wulf, Hinnerk /

Larmann, Jan / Corneci, Dan / Chammartin-Basnet, Frederique / Howell, Simon J

British journal of anaesthesia

2023 Volume 130, Issue 6, Page(s) 655–665

Abstract: Background: Guidelines endorse self-reported functional capacity for preoperative cardiovascular assessment, although evidence for its predictive value is inconsistent. We hypothesised that self-reported effort tolerance improves prediction of major ... ...

Abstract	Background: Guidelines endorse self-reported functional capacity for preoperative cardiovascular assessment, although evidence for its predictive value is inconsistent. We hypothesised that self-reported effort tolerance improves prediction of major adverse cardiovascular events (MACEs) after noncardiac surgery. Methods: This is an international prospective cohort study (June 2017 to April 2020) in patients undergoing elective noncardiac surgery at elevated cardiovascular risk. Exposures were (i) questionnaire-estimated effort tolerance in metabolic equivalents (METs), (ii) number of floors climbed without resting, (iii) self-perceived cardiopulmonary fitness compared with peers, and (iv) level of regularly performed physical activity. The primary endpoint was in-hospital MACE consisting of cardiovascular mortality, non-fatal cardiac arrest, acute myocardial infarction, stroke, and congestive heart failure requiring transfer to a higher unit of care or resulting in a prolongation of stay on ICU/intermediate care (≥24 h). Mixed-effects logistic regression models were calculated. Results: In this study, 274 (1.8%) of 15 406 patients experienced MACE. Loss of follow-up was 2%. All self-reported functional capacity measures were independently associated with MACE but did not improve discrimination (area under the curve of receiver operating characteristic [ROC AUC]) over an internal clinical risk model (ROC AUC Conclusions: Assessment of self-reported functional capacity expressed in METs or using the other measures assessed here did not improve prognostic accuracy compared with clinical risk factors. Caution is needed in the use of self-reported functional capacity to guide clinical decisions resulting from risk assessment in patients undergoing noncardiac surgery. Clinical trial registration: NCT03016936.
MeSH term(s)	Humans ; Prospective Studies ; Self Report ; Postoperative Complications/etiology ; Myocardial Infarction/etiology ; Risk Assessment ; Risk Factors
Language	English
Publishing date	2023-04-01
Publishing country	England
Document type	Journal Article
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1016/j.bja.2023.02.030
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