Prediction of Mortality after Cardiac and Noncardiac Surgery Using Cerebral Near-Infrared Spectroscopy: A Narrative Review
Background: Cerebral tissue oxygen saturation monitoring using near-infrared spectroscopy (NIRS) is widely employed during cardiac surgery. Although NIRS devices are approved for monitoring cerebral oxygenation, they are not licensed for prognostic purposes. Nevertheless, multiple studies have demonstrated significant associations between baseline cerebral NIRS values measured before anesthesia induction and postoperative mortality after cardiac and noncardiac surgery in adults, suggesting a potential role for baseline NIRS values in mortality risk prediction. This narrative review summarizes current evidence regarding the association between baseline cerebral NIRS values and postoperative mortality, focusing primarily on adult cardiac and noncardiac surgery and exclusively on mortality rather than composite morbidity endpoints.
Methods: A comprehensive PubMed search was conducted to identify studies investigating the relationship between cerebral NIRS values and postoperative mortality in adult surgical patients.
Results: Six studies evaluating adult cardiac surgery patients and three studies involving adult noncardiac surgery patients were identified. All studies but one demonstrated a significant association between low baseline cerebral NIRS values recorded before anesthesia induction and increased postoperative mortality. These findings suggest that baseline NIRS values reflect underlying cardiac functional reserve and systemic oxygen delivery capacity. Emerging evidence also suggests potential inter-device differences in mortality prediction performance among commonly used NIRS technologies.
Conclusions: Baseline cerebral NIRS values may serve as convenient, useful predictors of postoperative mortality. This review highlights the mechanistic basis of this association and discusses potential differences in prognostic performance among NIRS devices, underscoring the need for further large-scale comparative studies.
DOI: 10.29245/2578-3025/2026/1.1235 View / Download PdfTherapeutic Optimization in Elderly Patients with Heart Failure and Reduced Ejection Fraction: Real-World Evidence and the Importance of Timing
Heart failure with reduced ejection fraction (HFrEF) is highly prevalent among elderly patients, who frequently present with multimorbidity and frailty and are therefore at very high risk of hospitalization and mortality. Despite strong evidence supporting guideline-directed medical therapy (GDMT), therapeutic optimization remains suboptimal in this population, largely due to concerns regarding tolerability and comorbidities.
Emerging real-world data suggest that the early post-discharge period may represent a critical “window of opportunity” for therapeutic optimization in elderly patients with HFrEF. In this very high-risk population, early initiation and structured titration of disease-modifying therapies may confer substantial absolute benefits, potentially greater than those observed in lower-risk profiles, although this hypothesis requires further investigation.
This mini-review summarizes current evidence on GDMT implementation in elderly patients with HFrEF, with a focus on real-world experience, barriers to optimization, and the prognostic relevance of reducing heart failure hospitalizations. Unresolved controversies regarding patient selection, frailty, and outcome prioritization are discussed. Overall, available evidence suggests that age alone should not preclude therapeutic optimization and that structured, individualized approaches during this early phase may improve outcomes in elderly patients with HFrEF.
DOI: 10.29245/2578-3025/2026/1.1238 View / Download PdfRisk of Mortality and Cardiovascular Complications Following Retinal Vein Occlusion: A Mini-Review
Introduction: Retinal vein occlusion (RVO) is a condition in which one of the veins supplying the retina is occluded, causing acute vision changes. This event is often a signal of underlying cardiovascular disease and increases the risk for future adverse cardiovascular events.
Aim & method: This mini-review aims to provide an overview of pertinent studies investigating the relationship between RVO and increased risk of cardiovascular events and mortality, as well as treatments proposed to mitigate this risk.
Results: Pubmed database was searched for studies on RVO and risk of cardiovascular and mortality. 41 studies met criteria for inclusion. Following RVO, there was found to be a consistently elevated risk for myocardial infarction and cerebrovascular event, highest in the first year. There was also a mildly increased risk post-RVO for deep vein thrombosis and atrial fibrillation, but not for pulmonary embolism. Recent studies have also suggested that there is an increased risk for all-cause mortality after RVO. Central RVO may be more strongly associated with cardiovascular events as compared to branch RVO. To mitigate cardiovascular morbidity and mortality, treatment has been aimed at preventing atherosclerosis. Statin therapy post-RVO was found to significantly decrease cardiovascular risk.
Conclusion: While the relationship between RVO and cardiovascular disease has yet to be fully elucidated, evidence indicates that RVO is a strong predictor for future cardiovascular events, particularly acute myocardial infarction and cerebrovascular event. Ophthalmologists should work closely with primary care physicians and cardiologists following RVO to ensure proper risk assessment and treatment. These preventative interventions could reduce mortality and morbidity after RVOs.
DOI: 10.29245/2578-3025/2026/1.1237 View / Download Pdf