Pathological findings associated with the updated European Society of Cardiology 2022 guidelines for preoperative cardiac testing: an observational cohort modelling study

Alexandra Stroda; Eckhard Mauermann; Daniela Ionescu; the MET-REPAIR investigators; Wojciech Szczeklik; Stefan De Hert; Miodrag Filipovic; Beatrice Beck Schimmer; Savino Spadaro; Purificación Matute; Michael T. Ganter; Alexey Ovezov; Sanem C. Turhan; Judith van Waes; Filipa Lagarto; Kassiani Theodoraki; Anil Gupta; Hans Jörg Gillmann; Luca Guzzetti; Katarzyna Kotfis; Jan Larmann; Dan Corneci; Donal J. Buggy; Simon J. Howell; Giovanna Lurati Buse; Johann Kemper; Lena Kohaupt; Jette Witzler; Michael Tuzhikov; Sebastian Roth; René M'Pembele; Theresa Tenge; Cornelia Schultze; Nele Verbarg; Christian Gehrke; Anna Katharina Klemann; Friederike Hagebölling; Svenja Albrecht; Jakob Stroeder; Ann Kristin Schubert; Florian Espeter; Benedikt Russe; Markus A. Weigand; Lars Bergmann; Matthias Unterberg; Petra Bischoff; Raphael Pirzer; Patric Rene Rach; Klaus Ott; Seppe Koopman; Felix Van Lier

doi:10.1016/j.bja.2023.12.036

Pathological findings associated with the updated European Society of Cardiology 2022 guidelines for preoperative cardiac testing: an observational cohort modelling study

Alexandra Stroda^*, Eckhard Mauermann, Daniela Ionescu, the MET-REPAIR investigators, Wojciech Szczeklik, Stefan De Hert, Miodrag Filipovic, Beatrice Beck Schimmer, Savino Spadaro, Purificación Matute, Michael T. Ganter, Alexey Ovezov, Sanem C. Turhan, Judith van Waes, Filipa Lagarto, Kassiani Theodoraki, Anil Gupta, Hans Jörg Gillmann, Luca Guzzetti, Katarzyna KotfisJan Larmann, Dan Corneci, Donal J. Buggy, Simon J. Howell, Giovanna Lurati Buse, Johann Kemper, Lena Kohaupt, Jette Witzler, Michael Tuzhikov, Sebastian Roth, René M'Pembele, Theresa Tenge, Cornelia Schultze, Nele Verbarg, Christian Gehrke, Anna Katharina Klemann, Friederike Hagebölling, Svenja Albrecht, Jakob Stroeder, Ann Kristin Schubert, Florian Espeter, Benedikt Russe, Markus A. Weigand, Lars Bergmann, Matthias Unterberg, Petra Bischoff, Raphael Pirzer, Patric Rene Rach, Klaus Ott, Seppe Koopman, Felix Van Lier

^*Corresponding author for this work

Anesthesiology

Research output: Contribution to journal › Article › Academic › peer-review

4 Citations (Scopus)

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.

Original language	English
Pages (from-to)	675-684
Number of pages	10
Journal	British Journal of Anaesthesia
Volume	132
Issue number	4
DOIs	https://doi.org/10.1016/j.bja.2023.12.036
Publication status	Published - Apr 2024

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10.1016/j.bja.2023.12.036

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Stroda, A., Mauermann, E., Ionescu, D., the MET-REPAIR investigators, Szczeklik, W., De Hert, S., Filipovic, M., Beck Schimmer, B., Spadaro, S., Matute, P., Ganter, M. T., Ovezov, A., Turhan, S. C., van Waes, J., Lagarto, F., Theodoraki, K., Gupta, A., Gillmann, H. J., Guzzetti, L., ... Van Lier, F. (2024). Pathological findings associated with the updated European Society of Cardiology 2022 guidelines for preoperative cardiac testing: an observational cohort modelling study. British Journal of Anaesthesia, 132(4), 675-684. https://doi.org/10.1016/j.bja.2023.12.036

@article{90b5fb4796d74c6e8c81697942d5ea10,

title = "Pathological findings associated with the updated European Society of Cardiology 2022 guidelines for preoperative cardiac testing: an observational cohort modelling study",

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.",

author = "Alexandra Stroda and Eckhard Mauermann and Daniela Ionescu and {the MET-REPAIR investigators} and Wojciech Szczeklik and {De Hert}, Stefan and Miodrag Filipovic and {Beck Schimmer}, Beatrice and Savino Spadaro and Purificaci{\'o}n Matute and Ganter, {Michael T.} and Alexey Ovezov and Turhan, {Sanem C.} and {van Waes}, Judith and Filipa Lagarto and Kassiani Theodoraki and Anil Gupta and Gillmann, {Hans J{\"o}rg} and Luca Guzzetti and Katarzyna Kotfis and Jan Larmann and Dan Corneci and Buggy, {Donal J.} and Howell, {Simon J.} and {Lurati Buse}, Giovanna and Johann Kemper and Lena Kohaupt and Jette Witzler and Michael Tuzhikov and Sebastian Roth and Ren{\'e} M'Pembele and Theresa Tenge and Cornelia Schultze and Nele Verbarg and Christian Gehrke and Klemann, {Anna Katharina} and Friederike Hageb{\"o}lling and Svenja Albrecht and Jakob Stroeder and Schubert, {Ann Kristin} and Florian Espeter and Benedikt Russe and Weigand, {Markus A.} and Lars Bergmann and Matthias Unterberg and Petra Bischoff and Raphael Pirzer and Rach, {Patric Rene} and Klaus Ott and Seppe Koopman and {Van Lier}, Felix",

note = "Publisher Copyright: {\textcopyright} 2024 British Journal of Anaesthesia",

year = "2024",

month = apr,

doi = "10.1016/j.bja.2023.12.036",

language = "English",

volume = "132",

pages = "675--684",

journal = "British Journal of Anaesthesia",

issn = "0007-0912",

publisher = "Elsevier Ltd.",

number = "4",

}

Stroda, A, Mauermann, E, Ionescu, D, the MET-REPAIR investigators, Szczeklik, W, De Hert, S, Filipovic, M, Beck Schimmer, B, Spadaro, S, Matute, P, Ganter, MT, Ovezov, A, Turhan, SC, van Waes, J, Lagarto, F, Theodoraki, K, Gupta, A, Gillmann, HJ, Guzzetti, L, Kotfis, K, Larmann, J, Corneci, D, Buggy, DJ, Howell, SJ, Lurati Buse, G, Kemper, J, Kohaupt, L, Witzler, J, Tuzhikov, M, Roth, S, M'Pembele, R, Tenge, T, Schultze, C, Verbarg, N, Gehrke, C, Klemann, AK, Hagebölling, F, Albrecht, S, Stroeder, J, Schubert, AK, Espeter, F, Russe, B, Weigand, MA, Bergmann, L, Unterberg, M, Bischoff, P, Pirzer, R, Rach, PR, Ott, K, Koopman, S & Van Lier, F 2024, 'Pathological findings associated with the updated European Society of Cardiology 2022 guidelines for preoperative cardiac testing: an observational cohort modelling study', British Journal of Anaesthesia, vol. 132, no. 4, pp. 675-684. https://doi.org/10.1016/j.bja.2023.12.036

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 et al.
In: British Journal of Anaesthesia, Vol. 132, No. 4, 04.2024, p. 675-684.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Pathological findings associated with the updated European Society of Cardiology 2022 guidelines for preoperative cardiac testing

T2 - an observational cohort modelling study

AU - Stroda, Alexandra

AU - Mauermann, Eckhard

AU - Ionescu, Daniela

AU - the MET-REPAIR investigators

AU - Szczeklik, Wojciech

AU - De Hert, Stefan

AU - Filipovic, Miodrag

AU - Beck Schimmer, Beatrice

AU - Spadaro, Savino

AU - Matute, Purificación

AU - Ganter, Michael T.

AU - Ovezov, Alexey

AU - Turhan, Sanem C.

AU - van Waes, Judith

AU - Lagarto, Filipa

AU - Theodoraki, Kassiani

AU - Gupta, Anil

AU - Gillmann, Hans Jörg

AU - Guzzetti, Luca

AU - Kotfis, Katarzyna

AU - Larmann, Jan

AU - Corneci, Dan

AU - Buggy, Donal J.

AU - Howell, Simon J.

AU - Lurati Buse, Giovanna

AU - Kemper, Johann

AU - Kohaupt, Lena

AU - Witzler, Jette

AU - Tuzhikov, Michael

AU - Roth, Sebastian

AU - M'Pembele, René

AU - Tenge, Theresa

AU - Schultze, Cornelia

AU - Verbarg, Nele

AU - Gehrke, Christian

AU - Klemann, Anna Katharina

AU - Hagebölling, Friederike

AU - Albrecht, Svenja

AU - Stroeder, Jakob

AU - Schubert, Ann Kristin

AU - Espeter, Florian

AU - Russe, Benedikt

AU - Weigand, Markus A.

AU - Bergmann, Lars

AU - Unterberg, Matthias

AU - Bischoff, Petra

AU - Pirzer, Raphael

AU - Rach, Patric Rene

AU - Ott, Klaus

AU - Koopman, Seppe

AU - Van Lier, Felix

PY - 2024/4

Y1 - 2024/4

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85184759945&partnerID=8YFLogxK

U2 - 10.1016/j.bja.2023.12.036

DO - 10.1016/j.bja.2023.12.036

M3 - Article

C2 - 38336516

AN - SCOPUS:85184759945

SN - 0007-0912

VL - 132

SP - 675

EP - 684

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 4

ER -

Pathological findings associated with the updated European Society of Cardiology 2022 guidelines for preoperative cardiac testing: an observational cohort modelling study

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