ORIGINAL ARTICLES Value of electrocardiogram and chest X-ray examinations in preoperative management E6 | VNITŘNÍ LÉKAŘSTVÍ / Vnitř Lék. 2024;70(8):E3-E10 / www.casopisvnitrnilekarstvi.cz A preoperative adjustment in beta-blocker or anti-arrhythmic therapy was recommended in 8 (0.34%) patients. An unnecessary test or delay in surgery, due to an abnormal ECG and CXR finding, occurred in 35 (1.48%) and 16 (0.68%) patients, respectively. Reasons for unnecessary tests and delays are listed in Table 4. The relationship between selected patient characteristics and PCCS due to ECG and CXR findings is shown in Tables 5 and 6. All patients with a PCCS due to an SVT on the ECG had a significantly higher heart rate (HR) than those without an SVT (mean HR: 141 vs. 79 bpm, p=0.001). All patients with an SVT had an HR above 124 bpm. These patients were also significantly older than the others (mean 77 vs. 63 years, p=0.048), and all were over 71 years old. Further analysis showed that ages ≥72 years and heart rates ≥125 bpm were statistically significant predictors of a change in preoperative management, due to an abnormal ECG (Table 7). There Tab. 2. Characteristics of a physiological ECG; any ECG findings other than those listed were considered abnormal Parameter Normal Values Rhythm sinus rhythm, including respiratory arrhythmia Rate below 100 beats/min PQ interval 120-200 ms QRS interval below 120 ms QT interval below 450 ms ST segment no changes in ST segment T wave negative T wave in leads III, aVR, V1 Tab. 3. Characteristics of an abnormal chest X-ray Characteristic Diagnosis Cardiothoracic index above 0.5 aortic dilatation pulmonary congestion fluidothorax mediastinal dilatation pneumonia atelectasis tracheal deviation or stenosis pleuritis adhesions or post-inflammatory changes emphysema tumor or metastases rib fractures pneumothorax Tab. 4. Reasons for unnecessary testing or surgery delay, with no change in pre-operative management Aortic dilatation on CXR, TTE with only mild dilatation Poorly described CXR image Suspected pneumothorax, CT negative Pulmonary congestion on CXR, TTE normal or insignificant Pneumonia on CXR, but surgery urgent CTI above 0.5, TTE with restrictive filling pattern Pneumonia on CXR, pulmonary consult negative Ischemic changes on ECG, biomarkers negative Ischemic changes on ECG, TTE negative Abnormal ECG, HCM on bed-side TTE, no risk or other change Atrial fibrillation on ECG, TTE with mid-range ejection fraction Abnormal ECG, TTE with reduced ejection fraction CXR – chest X-ray; TTE – transthoracic echocardiography; CT – computed tomography; CTI – car-diothoracic index; ECG – electrocardiogram; HCM – hypertrophic cardiomyopathy Tab. 5. Relationship between selected patient characteristics and surgery post-ponement or cancelation, due to electrocardiogram findings Parameter Category No Delay N = 2.358 PCCS N = 4 P Age, y 63 (±15) 77 (±6) 0.048 Hypertension No 1.029 (43.6) 1 (25.0) 0.637 Yes 1.329 (56.4) 3 (75.0) Chronic coronary syndrome No 1.971 (83.6) 1 (25.0) 0.016 Yes 387 (16.4) 3 (75.0) Chronic heart failure No 2.296 (97.4) 3 (75.0) 0.103 Yes 62 (2.6) 1 (25.0) Ischemic or hemorrhagic stroke No 2.154 (91.3) 3 (75.0) 0.305 Yes 204 (8.7) 1 (25.0) Atrial fibrillation No 2.167 (91.9) 2 (50.0) 0.036 Yes 191 (8.1) 2 (50.0) Diabetes No 1.820 (77.2) 4 (100.0) 0.580 Yes 538 (22.8) 0 (0.0) Pulmonary disease No 2.051 (87.0) 2 (50.0) 0.050 COPD 132 (5.6) 1 (25.0) AB 100 (4.2) 0 (0.0) ACOS 14 (0.6) 0 (0.0) Other 61 (2.6) 1 (25.0) BMI 27.8 (±5.6) 29.6 (±7.9) 0.402 Smoking Non-smoker 1.379 (58.5) 2 (50.0) 0.062 Smoker 702 (29.8) 0 (0.0) Ex-smoker 277 (11.7) 2 (50.0) Potassium, mmol/l 4.24 (±0.48) 4.13 (±0.22) 0.556 CRP, mg/l 8 (3–42) 68 (5–157) 0.292 Systolic blood pressure, mmHg 139 (±21) 128 (±18) 0.299 Diastolic blood pressure, mmHg 80 (±12) 71 (±10) 0.144 Heart rate, beats/min 79 (±16) 141 (±15) 0.001 Values are the mean (±standard deviation), number (%), or median (intraquartile range), as indicat-ed. PCCS – postponement or canceling of surgery; SD – standard deviation; COPD – chronic pul-monary obstructive disease; AB – bronchial asthma; ACOS – asthma-COPD overlap syndrome; BMI – body-mass index; CRP – C-reactive protein; IQR – interquartile range
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