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Background: We aimed to depict the electrocardiographic and echocardiographic aspects in patients before elective major vascular surgery. Methods: We evaluated through standard 12 lead electrocardiography and transthoracic echocardiography 469 patients with asymptomatic large abdominal aortic aneurysm (AAA), 334 with critical carotid stenosis (CAS), and 238 with advanced peripheral artery disease (PAD) before surgical revascularization. Results: Patients with AAA were predominantly males ( p  < .001) with normal sinus rhythm ( p  = .026), were more affected by atrioventricular block ( p  = .033) and left anterior fascicular block ( p  < .001). They also presented larger aortic root size ( p  < .001) and septal hypertrophy ( p  = .036), in addition, atrial fibrillation was less frequent in the same group ( p  = .023). Patients with CAS were of older age ( p  < .001) with a substantial number of females ( p  < .001). They presented less left ventricular segmental kinetic disorders and fewer dilated ventricles ( p  = .004 and p  < .001 respectively). Finally, those with PAD had reduced septal and posterior wall thickness ( p  < .01, p  = .009 respectively), greater mitral and aortic annular calcification ( p  < .001), and were more affected by previous myocardial infarction ( p  < .001). The PR interval, left anterior fascicular block and aortic root size were independently associated with aneurysm, previous myocardial infarction with PAD, while smaller left ventricular end systolic volumes with carotid artery stenosis. Conclusions: Patients with AAA were mostly affected by cardiac conduction disorders, septal hypertrophy, aortic root dilation and less affected by atrial fibrillation. Patients with CAS were older with more normal sized ventricles, whereas, previous myocardial infarction was most common amongst patients with peripheral artery disease.

Background: Preoperative cardiac assessment may essentially contribute to estimate the operative risk in vascular surgery.This study was undertaken to depict the clinical conditions and cardiac status in patients before elective major vascular surgery., Patients and Methods: 143 patients with asymptomatic critical aortic abdominal aneurysm, 119 with high-grade carotid stenosis, and 138 with advanced symptomatic ischemia due to peripheral artery disease were assigned to surgical revascularization. Preoperatively, all subjects completed detailed medical history, physical and laboratory examinations, electrocardiogram, and transthoracic echocardiography., Results: In patients with peripheral artery disease we identified more smokers (p < 0.05), diabetes (p < 0.01), hypertriglyceridemia (p < 0.05), previous myocardial infarction (p < 0.01); the asymptomatic aortic abdominal aneurysm group had a higher body mass index (p < 0.05), diastolic hypertension (p < 0.05), and most had left ventricular anterior hemiblocks (p < 0.001). Patients with critical carotid stenosis were older (p < 0.01), with greater systolic hypertension (p < 0.01), and with a less compromised left ventricular systolic function., Conclusions: Patients with peripheral artery disease were mostly affected by severe metabolic diseases and by worst cardiac conditions; patients with asymptomatic abdominal aortic aneurysms were of robust physique, and often had left ventricular anterior hemiblocks. Patients with critical carotid stenosis were older and had less cardiomyopathies.

In order to evaluate both quantitatively and qualitatively exercise ST response in females, we have studied 232 healthy subjects (age range 35-59 years): 82 women (mean age 45.8 years) and 150 men (mean age 46.1 years). All subjects had performed a maximal treadmill exercise in 1976 and were followed up for 6 years in order to exclude the presence of subclinical coronary artery disease. Exercise ST segment responses were evaluated in a single bipolar lead (CB5) and were classified as 'positive' by visual interpretation when a 1.0-mm or greater 'ischemic' ST depression occurred. A computer system was employed to evaluate exercise ST changes quantitatively. The following ST parameters were evaluated: ST depression at R + 80 ms point (ST2); mean ST depression (STmean), and ST time-voltage integral (STarea). Computer analysis of resting ECG has shown lower ST voltages in females than in males. ST2, STarea, and STmean changes from basal to maximal exercise values were not significantly different in men and women. A similar prevalence of 'positive' responses in males and females was also found by ECG visual interpretation. In conclusion, our data show that in healthy subjects exercise ST segment response is comparable in males and females and indirectly suggest that the lower predictive value of exercise ECG in women is likely to be related to different coronary artery disease prevalence.

To assess the diagnostic value of continuous ambulatory ECG in exercise angina pectoris, 49 males (mean age 52, 1 years), with exercise ischemic ECG changes and positive coronary angiography were evaluated. Ischemic ST-changes were detected by ambulatory ECG in 47% of those patients; most of these ST segment displacements were asymptomatic and a lot of them occurred at rest. In order to assess the specificity of ambulatory ECG, 90 healthy subjects (47 males and 43 females, mean age 43,6 years), were also evaluated 8.9% of these subjects developed ischemia like episodes of ST segment deviation. We conclude that in exercise angina pectoris the ambulatory ECG allows to recording silent ST segment changes, in spite of a poor diagnostic sensitivity. The low specificity of ST segment depression recorded by ambulatory ECG must be also emphasized.