Table 1
Lead
author
No.
patients
Patient group
Primary outcomes
Positive Results
Statistical significance
Rohde1
570
Elective major
non-cardiac
surgery
Primary cardiac arrest
MR
Cardiogenic APO
VF
Sustained CHB
LV systolic dysfunction
predicted POC
Mod/severe LVH predicted postoperative MI
Aortic stenosis >40mmHg
predicted POC
Abnormal pre-operative echo
predicted POC
OR 2.0 [CI 1.0-4.5]
OR 3.1 [CI 1.1-8.3]
OR 6.8 [CI 1.3-31], p=0.01
NPV 97%
Takase2
53
Elective nonvascular
surgery.
Patients with
suspected IHD
Cardiac death
MI
Unstable angina
APO
LV systolic dysfunction
associated with post-operative
APO
p=0.007
Kontos3
87
Elective noncardiac surgery
Cardiac death
MI
Revascularisation
before surgery
LVEF <50% predicted POC
Sensitivity 86%
Specificity 81%
PPV 43%
NPV 97%
Rossi4
110
Elective
peripheral
vascular surgery
Cardiac death
MI at one year
LVEF <40% predicted late
events
Sensitivity 53%
Specificity 91%
PPV 53%
NPV 93%
Halm5
339
Elective noncardiac surgery.
Patients with
known or
suspected IHD.
Ischaemia
VT
CCF
LVEF <40% predicted
combined POC
LV dysfunction predicted
combined POC
OR 2.5 [CI 1.2-5.0]
Elective
adrenalectomy
Haemodynamic
instability in intra- and
post-operative period
Abnormal TTE correlated with
post-operative CCF
p=0.06
Devaux6
63
OR 1.3, [CI 1.0-1.7]
All figures quoted are for multivariate analyses of the predictive effect of transthoracic echocardiography.
IHD = Ischaemic heart disease. MR = Mitral Regurgitation. APO = Acute pulmonary oedema. VF = Ventricular fibrillation. CHB =
Complete heart block. MI = Myocardial infarction. VT = Ventricular tachycardia. CCF = Congestive cardiac failure. LV = Left
ventricular. LVH = Left Ventricular Hypertrophy. LVEF = Left Ventricular Ejection Fraction. POC = Post-operative complication. OR
= Odds ratio. CI = Confidence Interval. PPV = Positive Predictive Value. NPV = Negative predictive value
1
Rohde LE, Polanczyk CA, Goldman L et al. Risk stratification of Patients Undergoing Peripheral Vascular Revascularization by
Combing Resting and Dipyridamole Echocardiography. Am J Cardiol 2001;87:505-509
2
Takase B, Younis LT, Byers SL et al. Comparative prognostic value of clinical risk indexes, resting two-dimensional
echocardiography, and dipyridamole stress thallium-201 myocardial imaging for perioperative cardiac events in major nonvascular
surgery patients. Am Heart J. 1993; 126 (5) 1099-1106
3
Kontos MC, Brath LK, Akosah KO et al. Cardiac complications in noncardiac surgery: Relative value of resting two-dimensional
echocardiography and dipyridamole thallium imaging. Am Heart J 1996;132:559-66
4
Rossi E, Citterio F, Vescio MF et al. Risk Stratification of Patients Undergoing Peripheral Vascular Revascularisation by Combined
Resting and Dipyridamole Thallium Imaging. Am J Cardiol 1998; 82 (3), p306-310
5
Halm EA, Browner WS, Tubau JF et al. Echocardiography for Assessing Cardiac Risk in Patients Having Noncardiac Surgery.
Annals of Internal Medicine 1996 126;6:433-441.
6
Devaux B, Lentschener C, Jude N et al. Predictive value of preoperative Transthoracic echocardiography in patients undergoing
adenalectomy for phaeochromocytoma. Acta Anaestheiol Scand 2004; 48: 711-715