Can exercise MUGA predict perioperative risk and long-term outcome in patients undergoing abdominal aortic surgery?

Abdominal aortic surgery (AAS) is associated with a high risk of perioperative and long-term cardiac events. We investigated whether exercise radionuclide ventriculography (ex MUGA) identifies patients (pts) at particular risk. 161 pts had ex MUGA: 122 (76%) went on to have AAS as planned, whilst 39 (24%) had no or lower risk surgery. Mean follow-up (FU) was 4y. Clinical risk score (CRS; L'Italien et al) was the sum of: age>70y 0.5, diabetes 0.8, angina 0.8, MI 0.5, LVF 0.6, CABG within 5y -2.2. Ex MUGA was abnormal if LV ejection fraction <40% at rest, and/or failed to increase during exercise. Cardiac events were unstable angina, MI, LVF, CABG, or cardiac death. Periop event-rate was 5/122 (4%) for AAS. Compared with pts undergoing AAS, those who had no or lower risk surgery were at high risk of a FU event (39% v 16%, P=0.005). 8 pts underwent coronary intervention prior to AAS and suffered no periop events. Both CRS and ex MUGA predicted FU events: (Graph Presented) In low CRS pts, FU events occurred in 11/79 (14%) with a normal ex MUGA, compared with 5/18 (28%) with an abnormal ex MUGA. In high CRS pts, FU events occurred in 5/19 (26%) v 8/17 (47%). Using both CRS and ex MUGA to guide case selection, AAS can be performed with low periop risk. Ex MUGA may provide additional information about long-term cardiac cutlook when surgery is considered on predominantly prognostic grounds.