| Objective To compare the clinic predictive value of several evaluation systems on perioperative cardiavascular risk events(CRE), including Goldman index, the number of cardiavascular risk factors(CVRFs), American society of anesthesiologists classification(ASA), New York Asssociation classification,(NYHA),objective auxiliary examination evaluation,Metabolic equivalents(METs).We studied (1)the significance of CVRFs,ASA classification,NYHA classification,objective auxiliary examination evaluation, METs and Goldman index that have been used for evaluation about the pre-and post operative cardiovascular autonomic nervous dysfunction;(2) analysised the relative degree between CVRF s, AS A classification,NYHA, objective auxiliary examination evaluation or Goldman index and METs respectively;(3) compared the accuracy of these evaluation systems used for risk stratification on perioperative silent myocardial ischemia(SMI), major adverse cardiac events(MACE) and high risk ventricular ectopic beats(HRVEB).Method One hundred and two patients scheduled for elective noncardiac surgery were selected, and have been evaluated the cardiovascular risk according CVRFs, ASA classification, NYHA classification, objective auxiliary examination evaluation, METs and Goldman index successively, and divided into corresponding groups with the risk stratification results respectively. Record the pre-and post operative MACE, such as myocarioal ischemic, angina, atrial fibrillation, non fatality myocardial infarction, congestive heart-failure, cardiac arrest, cardiac sudden death and so on. Each patient’s electrocardiograph was continuously monitored with a portable dynamic electrocardiogram (DCG) data collector in the preoperative day and the1st and2nd post operative days. SMI and HRVEB(including frequent ventricular ectopic beats, ventricular couplets, nonsustained ventricular tachycardia, sustained ventricular tachycardia)were diagnosed according the electrocardiosignal data through manual analysis and dynamic Holter system software. The frequence parameters of heart rate variability(HRV), including total power(TP), high frequency(HF), low frequency(LF), very low frequency(VLF) and the ratio of low frequency to high frequency (LF/HF), were collected and computed during the pre-and post-operative periods from twenty three intraday to seven in the early morrow morning in the preoperative day and the1st and2nd post operative days. Significant difference of TP、HF、LF、VLF、LF/HF among patients in different risk stratifications according CVRFs, ASA classification, NYHA classification, objective auxiliary examination evaluation or Goldman index and METs respectively were analyzed by one-way ANOVA successively. Significant difference of TP,HF,LF,VLF and LF/HF among the preoperative day, the1st and2nd post operative days in different risk stratifications patients according CVRFs, ASA classification, NYHA classification,objective auxiliary examination evaluation, Goldman index and METs respectively were analyzed by repeated measures analysis of variance successively. Correlation between risk stratifications result of defferent CRE evaluation systems and respective TP,HF,LF,VLF,LF/HF in preoperative day or post operative days were analyzed by Spearman correlation test. Correlation between risk stratifications result according CVRFs, ASA classification, NYHA classification, objective auxiliary examination evaluation or Goldman index and METs were analyzed by Spearman correlation test respectively. The predictive ability, to SMI,MACE and HRVEB, of each risk stratification system was evaluated using receiver operating characteristic (ROC) curve analysis.Results (1)The general trend of HRV parameter were decreased in high risk stratification patients compared with low risk stratification in every CRE evaluation systems. In CVRFs risk stratification system, The preoperative TP, HF, LF, VLF and LF/HF showed significantly stactistic difference among groups; TP, HF, LF and VLF showed significantly stactistic difference among groups in the two post operative days. In ASA classification risk stratification system, TP, HF, LF and VLF in the preoperative day showed significantly stactistic difference among groups; TP, LF,VLF and LF/HF in the2nd post operative day showed significantly stactistic difference. In Goldman index risk stratification system, the preoperative HRV parameter showed decreased trend but non-significantly stactistic difference; but LF/HF and LF appeared significant difference after surgery. In NYHA classification risk stratification system, the decreased trend of HRV frequence parameter showed non-significantly stactistic difference during the perioperative period. In objective auxiliary examination risk stratification system, the preoperative HRV parameter showed non-significantly stactistic difference; but TP and LF appeared significant difference in the1st post operative day. In METs risk stratification system, the preoperative TP, LF, VLF showed significantly stactistic difference; the postoperative LF/HF showed significantly stactistic difference.In the preoperative day, The CVRFs and ASA risk stratification were lowly or weak negative correlation with TP、HF、LF、VLF; METs was weak positive correlation with the preoperative TP、LF、VLF. In the1st preoperative day, the CVRFs and Goldman index risk stratification were lowly or weak negative correlation with TP, LF, VLF; Goldman index and METs were weak negative correlation with LF/HF. In the2nd postoperative day, CVRFs and Goldman index were lowly or weak negative correlation with TP,LF,VLF;CVRFs was correlation with HF; Goldman index was weak correlation with LF/HF; ASA classification was weak correlation with TP and LF.(2)The general trend of METs were decreased in high risk stratification patients compared with low risk stratification in each risk stratification system. In CVRFs evaluation systems, ASA classification and NYHA classification, the decrease of METs were statistically significant. Correlation analysis showed that CVRFs and ASA were low correlation with METs(r>0.3); NYHA classification and objective auxiliary examination evaluation were weak correlation with METs (r<0.3).(3)Area of parients SMI ROC curve according CVRFs, ASA classification, NYHA classification, objective auxiliary examination evaluation, METs or Goldman index risk stratification system were0.785,0.664,0.623,0.670,0.681,0.766respectively(P<0.01or0.05).Area of MACE ROC curve according CVRFs or Goldman index risk stratification system were0.741or0.715respectively(P<0.05).Area of HRVEB ROC curve according Goldman index or ASA classification risk stratification system were0.653or0.674respectively(P<0.05).Conclusion (1)HRV Parameters, that reflect the function of autonomic nervous, shows decrease trend in high risk stratification patients, according CVRFs, ASA classification, Goldman index, NYHA classification,objective auxiliary examination... |
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