Please select the eligibility criteria that correspond to the clinical trial below.
Title: Perioperative Myocardial Ischemia in Isolated Systolic Hypertension (PROMISE)
Brief Summary: During or after surgery, patients may suffer heart attacks or other heart complications, increasing the hospital stay by 11 days on average and costing an estimated US$20 billion in 1990.Many risk factors have been identified but there are no properly conducted studies to look at Blood pressure (BP) as a risk factor around the time of surgery. The investigators believe there is a good possibility that systolic BP (SBP) is a risk factor but currently unrecognized. When measuring BP, two numbers are obtained. The upper number is called SBP and a lower number called diastolic BP (DBP). If the numbers are high, this means that the patient has a high BP or hypertension. If the SBP is high while DBP is normal, it is called isolated systolic hypertension (ISH)\> ISH is increasingly recognized as a major risk factor for heart problems. The relationship between ISH and heart complications around the time of surgery is poorly understood. Previous studies did not look at such a relationship. Because of that, there are no guidelines for ISH management at the time of surgery. Generally, these patients go through surgery as if they have no increased risk. Studies are starting to show that the bulk of these heart complications happen in patients thought to have low risk factors not yet identified, including ISH.

The investigators believe that the oxygen supply to the heart can be compromised around the time of surgery in ISH patients Chemicals known as stress hormones are secreted around the time of surgery, increasing oxygen needs in the heart and may make the oxygen supply to the heart muscle critical (know as myocardial ischemia). This in turn may result in a heart attack and death. Studies have shown that patients with myocardial ischemia stand a 9-fold increase in odds ratio of suffering a heart attack, worsening of angina, or death.

This study aims to compare the incidence of myocardial ischemia in patients with ISH and normal BP patients around the time of surgery using a special heart monitor. In addition, the study aims to determine the prevalence of ISH among surgical patients and to document complications like heart attacks, heart failure, stroke and death after surgery.

This research project will be conducted at the Ottawa Hospital by a multi-disciplinary research group (perioperative research group)which includes anesthesiology, cardiology, general surgery and epidemiology. The research group secured HSFO funding for this study.


Options:
A: Inclusion Criteria:

* Age ≥ 45 years
* ISH or normotensive (as per Patient Recruitment and Informed Consent section)
* Elective non cardiac surgical procedure
* Expected to stay in hospital ≥ 48 hours
* Revised cardiac risk index (RCRI) ≤ 251

Exclusion Criteria:

* Atrial fibrillation
* Left bundle branch block (LBBB)
* Myocardial infarction \< 3 months
* Decompensated congestive heart failure
* Unstable coronary syndrome
* Dialysis
* Emergency surgery
B: Inclusion Criteria:

* Established diagnosis of B-CLL by NCI criteria, performed by local haematologist. (Diagnosis will be confirmed by the biological review committee according to flow cytometry analysis (positive clusters of differentiation antigen 5 (CD5), 19 (CD19),23 (CD23)).
* Age \> 18 years and \< 70 years.
* Eastern Cooperative Oncology Group (ECOG)\<=2.
* Binet stage A.
* Diagnosis performed within 12 months before inclusion in the study.
* Patients who do not necessitate therapy by NCI guidelines (watch and wait policy).
* Shipment of peripheral blood sample to centralized laboratory for biological assessment.
* Clinical data including baseline information on disease localization and laboratory parameters at staging and assurance of follow up updating for at least 3 years are requested.
* Written informed consent.

Exclusion Criteria:

* Patients with CLL whose diagnosis exceed 12 months before registration.
* Patients with leukemic phase of lymphoproliferative disorders of B origin CD5- and/or CD23- according to flow cytometry analysis.
* Clinical Binet stage B or C.
* Patients who necessitate therapy according to NCI guide-lines (no watch and wait policy).
* Age \> 70 years.
* Without a written informed consent.
C: Inclusion Criteria:

* All patients who undergo noncardiac surgery are eligible if they are \> 45 years of age and receive a general or regional anesthetic (i.e., plexus block, spinal, or epidural).

Exclusion Criteria:

* We will exclude patients undergoing noncardiac surgery who do not require at least an overnight hospital admission after surgery or who only receive infiltrative (i.e., local) or topical anesthesia.
* We will also exclude patients previously enrolled in the VISION Study and patients who do not consent to participate.
D: Inclusion Criteria:

1. Age ≥ 18 years.
2. Patients who have undergone cardiac surgery. This includes coronary artery bypass grafting and all open heart procedures such as valvular repairs/replacement.

Exclusion Criteria:

1. Previously enrolled in the VISION Cardiac Surgery Study.
2. Patients who have undergone an isolated pericardial window, pericardiectomy, permanent pacemaker or defibrillator implantation.

Answer: A