Lead author

No. patients

Patient group Primary outcomes Positive Results Statistical significance

Rohde1 570 Elective major non-cardiac surgery

Primary cardiac arrestMRCardiogenic APOVFSustained CHB

LV systolic dysfunction predicted POCMod/severe LVH predicted post-operative MIAortic 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 non-vascular surgery.Patients with suspected IHD

Cardiac deathMIUnstable anginaAPO

LV systolic dysfunction associated with post-operative APO

p=0.007

Kontos3 87 Elective non-cardiac surgery

Cardiac deathMIRevascularisation before surgery

LVEF <50% predicted POC Sensitivity 86%Specificity 81%PPV 43%NPV 97%

Rossi4 110 Elective peripheral vascular surgery

Cardiac deathMI at one year

LVEF <40% predicted late events

Sensitivity 53%Specificity 91%PPV 53%NPV 93%

Halm5 339 Elective non-cardiac surgery. Patients with known or suspected IHD.

IschaemiaVTCCF

LVEF <40% predicted combined POCLV dysfunction predicted combined POC

OR 2.5 [CI 1.2-5.0]

OR 1.3, [CI 1.0-1.7]

Devaux6 63 Elective adrenalectomy

Haemodynamic instability in intra- and post-operative period

Abnormal TTE correlated with post-operative CCF

p=0.06

Table 1

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

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