Echocardiographic Estimated Pulmonary Systolic Pressure and Outcome After Noncardiac-Obstetrics Surgery in Postcapillary Pulmonary Hypertensive Patients

Am J Cardiol. 2022 Apr 15:169:127-135. doi: 10.1016/j.amjcard.2021.12.047. Epub 2022 Jan 20.

Abstract

Pulmonary hypertension is associated with increased postoperative risk. This study analyzed the relation between the preoperative echocardiographic estimated blood pressure (estimated pulmonary arterial systolic pressure [ePASP]) of noncardiac patients and postoperative cardiac outcome and tried to identify a clinically meaningful threshold for ePASP in postcapillary pulmonary hypertensive patients. This was a single-center retrospective cohort study with propensity score analysis based on patients who underwent elective noncardiac surgery from June 2012 to December 31, 2018. We evaluated the relation between ePASP and the development of postoperative major adverse cardiac events (MACEs). Multivariate logistic regression models and generalized additive models were used, and the minimum p value approach was used to identify the threshold of ePASP that independently indicated the risk of MACEs. Finally, propensity score matching was used for patients with ePASP above or below the threshold, and the exposure effect was evaluated. Of the 16,210 surgeries, 7.0% experienced postoperative MACEs. The threshold for the ePASP was 47 mm Hg. Adjusted odds ratios for MACEs before and after propensity score matching were 2.03 (1.22 to 2.83) and 1.62 (1.01 to 2.23), respectively. In conclusion, the incidence of postoperative MACEs was 7.0% in patients who underwent elective noncardiac surgery. An ePASP ≥47 mm Hg was significantly associated with an increased risk of postoperative MACEs in postcapillary pulmonary hypertensive patients.

MeSH terms

  • Blood Pressure
  • Echocardiography
  • Humans
  • Hypertension*
  • Obstetrics*
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • Risk Factors