The role of routine pre-operative bedside echocardiography in detecting aortic stenosis in patients with a hip fracture
S J Loxdale, J R Sneyd, A Donovan, G Werrett, D J Viira, S J Loxdale, J R Sneyd, A Donovan, G Werrett, D J Viira
Abstract
The prevalence and severity of aortic stenosis in unselected patients admitted with a hip fracture is unknown. Derriford Hospital operates a routine weekday, pre-operative, targeted bedside echocardiography examination on all patients admitted with a hip fracture. We carried out a prospective service evaluation for 13 months from October 2007 on all 501 admissions, of which 374 (75%) underwent pre-operative echocardiography. Of those patients investigated, 8 (2%) had severe, 24 (6%) moderate and 113 (30%) had mild aortic stenosis or aortic sclerosis. Eighty-seven of 278 (31%) patients with no murmur detected clinically on admission had aortic stenosis on echocardiography and of the 96 patients in whom a murmur was heard pre-operatively, 30 (31%) had a normal echocardiogram. Detection of a murmur does not necessarily reflect the presence of underling aortic valve disease. However, if a murmur is heard then the likelihood of the lesion's being moderate or severe aortic stenosis is increased (OR 8.5; 95% CI 3.8-19.5). Forty-four (12%) of our unselected patients with fractured femur had either moderate or severe aortic stenosis (with or without moderate or severe left ventricular failure), or mild stenosis with moderately or severely impaired left ventricular function.
Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland.
References
- Sandby-Thomas M, Sullivan G, Hall JE. A national survey into the peri-operative anaesthetic management of patients presenting for surgical correction of a fractured neck of femur. Anaesthesia 2008; 63: 250-8.
- McBrien ME, Heyburn G, Stevenson M, et al. Previously undiagnosed aortic stenosis revealed by auscultation in the hip fracture population-echocardiographic findings, management and outcome. Anaesthesia 2009; 64: 863-70.
- Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis and meta-regression. Canadian Journal of Anesthesia 2008; 55: 146-54.
- National Confidential Enquiry into Perioperative Deaths. Changing the Way we Operate. The 2001 Report of the National Confidential Enquiry into Perioperative Deaths. London: NCEPOD, 2001.
- Livanainen AM, Lindroos M, Tilvis R, Heikkila J, Kupari M. Natural history of aortic valve stenosis of varying severity in the elderly. American Journal of Cardiology 1996; 78: 97-101.
- Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of vascular heart disease: a population based study. Lancet 2006; 368: 1005-11.
- Bonow RO, Carabello BA, Kanu C, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association. Circulation 2006; 114: e84-231.
- Monin JL, Monchi M, Gest V, Duval-Moulin AM, Dubois-Rande JL, Gueret P. Aortic stenosis with severe left ventricular dysfunction and low transvalvular pressure gradients: risk stratification by low-dose dobutamine echocardiography. Journal of the American College of Cardiology 2001; 37: 2101-7.
- Munt B, Legget ME, Kraft CD, Miyake-Hull CY, Fujioka M, Otto CM. Physical examination in valvular aortic stenosis: correlation with stenosis severity and prediction of clinical outcome. American Heart Journal 1999; 137: 298-306.
Source: PubMed