LETTER
Preoperative Echocardiography for Noncardiac Surgery
Ted Palen, MD, PhD
1 June 1997 | Volume 126 Issue 11 | Page 919
TO THE EDITOR:
I commend Dr. Halm and his colleagues in the Study of Perioperative Ischemia Research Group for giving us valuable insight into the role of echocardiography in preoperative evaluations [1]. The comprehensive tables documenting the sensitivity, specificity, and predictive values of ejection fractions from echocardiograms illustrate that high technology is not always better than a thorough history and physical. However, I was disappointed that the authors did not delineate the manner in which information from the traditional clinical evaluation was incorporated into their clinical model. The authors state that several risk classification schemes were determined for each patient, but they do not state how the quantitative clinical scales were used. Therefore, I wonder why the diagnostic value of echocardiography was not compared with the diagnostic predictability of the preoperative risking schemes of the commonly used Goldman cardiac risk index [2], Detsky risk index [3], or other indexes [4, 5].
A comparison of the diagnostic value of echocardiography with that of currently used clinical diagnostic risking scales would help the working clinician better determine whether the traditional preoperative evaluation is really all that is needed.
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Author and Article Information
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University of Colorado Health Sciences Center, Denver, CO 80220
1. Halm EA, Browner WS, Tubau JF, Tateo IM, Mangano DT. Echocardiography for assessing cardiac risk in patients having noncardiac surgery. Study of Perioperative Ischemia Research Group. Ann Intern Med. 1996; 125:433-41.
2. Goldman L, Caldera DL, Nussbaum SR, Southwick FS, Krogstad D, Murray DS, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977; 297:845-50.
3. Detsky AS, Abrams HB, McLaughlin JR, Drucker DJ, Sasson Z, Johnston N, et al. Predicting cardiac complications in patients undergoing non-cardiac surgery. J Gen Intern Med. 1986; 1:211-9.
4. Criteria Committee of the New York Heart Association. Nomenclature and Criteria for the Diagnosis of Diseases of the Heart and Great Vessels. v 94. Boston: Little, Brown; 1979.
5. American Society of Anesthesiologists. New classification of physical status. Anesthesiology. 1963; 24:111.
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