Hurst, R. Todd

Evidence suggests that cardiovascular (CV) fitness below the 20 th percentile for age and gender is associated with increased cardiac death and all cause mortality. This study assessed the association between CV fitness and sub-clinical atherosclerosis (SCA) in a self-selected group of participants in a cardiology-based prevention program. The study involved a single visit observation of participants. 240 apparently healthy asymptomatic adults <65 years (69% male) received a maximal graded exercise stress test and a carotid intima-media thickness (CIMT) evaluation with B-mode ultrasound. CV fitness was classified based on age-gender norms (very poor=1-19 th , poor=20-39 th , fair=40-59 th , good=60-79 th , excellent/superior=80-100 th percentile). CIMT was used to define CV health based on age-gender-race norms. SCA was considered present when there was non-occlusive carotid artery plaque (>1.5mm and >50% of the surrounding intima-media) or CIMT >75 th percentile. Anyone with a prior history of clinically apparent atherosclerosis or diabetes was excluded from the study. The mean age of participants was 50 yrs (SD= 8.7). 113 participants (47%) had excellent/superior CV fitness. 41 (17%) were classified good, 36 (15%) fair, 20 (8%) poor and 30 (12%) very poor. 69 (61%) participants with excellent/superior CV fitness had advanced atherosclerosis (plaque=43%; n=49 or CIMT >75 th percentile=l7%; n=20). In the good classification there were 26 (64%) with plaque (49%; n=20) or CIMT >75 th percentile (15%; n=6). There were 23 (63%) in the fair classification with plaque (44%; n=16) or CIMT >75 th percentile (19%; n=7), 11 (55%) in the poor classification with plaque (45%; n=9) or CIMT >75 th percentile (10%; n=2) and 17 (56%) in the very poor classification with plaque (53%; n=16) or CIMT >75 th percentile (3%; n=1). 58 (24%) of the total number of participants were classified with superior CV fitness (95-100 th percentile); of which 36 (62%) had SCA (plaque=45%; n=26 or CIMT >75 th percentile=17%; n=10). In this self-selected population, CIMT testing detected evidence of SCA across all age-gender fitness classifications, which included very fit individuals. Further investigation is needed to identify other factors that may be associated with increased CV risk in apparently healthy fit asymptomatic adults.

Objectives. To determine the importance of acute cardiac events as a cause of mortality compared to non-cardiac events in the four month period following liver transplantation (LT) using current preoperative cardiac screening strategies.Patients and Methods. We retrospectively reviewed timing, type, and outcome of adverse cardiac events, and all cause mortality in the 4 month postoperative period in 393 consecutive LT patients from October 1999 to February 2008.Results. Of 30 total deaths (7.6% overall mortality rate), 27 (90%) were due to surgical or medical complications and 3 (10%) were primary cardiac deaths (0.8% cardiac mortality rate). Acute cardiac events occurred in 26 patients (6.6%), including 13 arrhythmias (50%), 7 new onset heart failures (27%), and 6 myocardial infarctions (23%). Twelve of 13 intraoperative events were arrhythmias (92%) including two of three cardiac deaths.Conclusions. Using current preoperative screening recommendations, deaths from primary cardiac events within four months of LT are very uncommon (0.8%), especially compared with deaths related to medical and surgical complications (6.9%).