TY - JOUR
T1 - Prognostic Markers of Outcome in Patients Undergoing Infra-inguinal Revascularisation
T2 - A Prospective Observational Pilot Study
AU - Kanakaraj, M.
AU - Yates, D. R.
AU - Wilson, R. J.T.
AU - Baroni, M. L.
AU - Davies, S. J.
N1 - Publisher Copyright:
© 2017 European Society for Vascular Surgery
PY - 2017/8
Y1 - 2017/8
N2 - Objectives The aim was to investigate whether cardiopulmonary exercise testing (CPET) variables derived from cycle and arm ergonometry correlate, and whether CPET variables and pre-operative N-terminal pro-brain natriuretic peptide (NT-proBNP) have prognostic significance and if the combination of the two has incremental value. Methods A prospective observational pilot study was conducted; 70 patients who underwent infra-inguinal bypass surgery were recruited. Pre-operatively subjects underwent CPET with both arm and leg ergonometry, to measure peak oxygen consumption, anaerobic threshold (AT), and ventilatory equivalents. In addition pre-operative serum samples of NT-proBNP were obtained. The primary endpoint was 1 year all-cause mortality; in addition, data were collected on complications, morbidity, length of stay, and major adverse cardiac events (MACE). Results The 1 year mortality rate was 6%, the overall complications rate was 23%, and the combined incidence of MACE and 1 year mortality was 10%. Cycle ergonometry peak VO2 14 mL/kg/min (RR 5.5, 95% CI 1.4–22.4, p =.007) and AT < 10mL/kg/min (RR 3.0, 95% CI 1.1–7.0, p =.03) were predictors of post-operative complications. Pre-operative NT-proBNP > 320 ng/L (RR 18, 95% CI 2.5–140 p =.0003) was the sole predictor of 1 year mortality or MACE. Conclusion The measurement of pre-operative NT-proBNP in peripheral vascular disease patients undergoing infra-inguinal bypass can predict 1 year mortality and MACE. CPET variables from cycle ergonometry are predictors of post-operative complications in this patient group.
AB - Objectives The aim was to investigate whether cardiopulmonary exercise testing (CPET) variables derived from cycle and arm ergonometry correlate, and whether CPET variables and pre-operative N-terminal pro-brain natriuretic peptide (NT-proBNP) have prognostic significance and if the combination of the two has incremental value. Methods A prospective observational pilot study was conducted; 70 patients who underwent infra-inguinal bypass surgery were recruited. Pre-operatively subjects underwent CPET with both arm and leg ergonometry, to measure peak oxygen consumption, anaerobic threshold (AT), and ventilatory equivalents. In addition pre-operative serum samples of NT-proBNP were obtained. The primary endpoint was 1 year all-cause mortality; in addition, data were collected on complications, morbidity, length of stay, and major adverse cardiac events (MACE). Results The 1 year mortality rate was 6%, the overall complications rate was 23%, and the combined incidence of MACE and 1 year mortality was 10%. Cycle ergonometry peak VO2 14 mL/kg/min (RR 5.5, 95% CI 1.4–22.4, p =.007) and AT < 10mL/kg/min (RR 3.0, 95% CI 1.1–7.0, p =.03) were predictors of post-operative complications. Pre-operative NT-proBNP > 320 ng/L (RR 18, 95% CI 2.5–140 p =.0003) was the sole predictor of 1 year mortality or MACE. Conclusion The measurement of pre-operative NT-proBNP in peripheral vascular disease patients undergoing infra-inguinal bypass can predict 1 year mortality and MACE. CPET variables from cycle ergonometry are predictors of post-operative complications in this patient group.
KW - Anaerobic threshold
KW - Arm crank
KW - Bike test
KW - Cardiopulmonary Exercise test
KW - Lower limb revascularisation
KW - NT-proBNP
KW - Peak VO
KW - Peripheral vascular disease
UR - http://www.scopus.com/inward/record.url?scp=85020745864&partnerID=8YFLogxK
U2 - 10.1016/j.ejvs.2017.05.005
DO - 10.1016/j.ejvs.2017.05.005
M3 - Article
C2 - 28625356
AN - SCOPUS:85020745864
VL - 54
SP - 212
EP - 219
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
SN - 1078-5884
IS - 2
ER -