Perioperative risk stratification in non cardiac surgery: role of pharmacological stress echocardiography

Sicari, Rosa

doi:10.1186/1476-7120-2-4

Cited by 7 publications

(2 citation statements)

References 56 publications

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“…184,186 Another important clinical situation for indication of stress echocardiography is the preoperative evaluation of patients undergoing intermediate-risk surgery. 179,187,189 Even in this situation, the method can be used but it should not generally replace the exercise test when this is possible. However, in vascular surgeries, where there are one or more risk factors, the investigation may start from the echocardiographic examination under stress.…”

Section: Coronary Artery Diseasementioning

confidence: 99%

Position Statement on Indications of Echocardiography in Adults - 2019

Barberato¹,

Romano

Beck

et al. 2019

Arquivos Brasileiros De Cardiologia

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Section: Coronary Artery Diseasementioning

confidence: 99%

Position Statement on Indications of Echocardiography in Adults - 2019

Barberato¹,

Romano

Beck

et al. 2019

Arquivos Brasileiros De Cardiologia

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“…Currently, surgeons' estimates of a patient's surgical risk before surgery differ greatly. Surgical risk calculators are infrequently utilized, despite their reliability (3) Due to differences in the de nition of PPCs, the overall incidence of postoperative pulmonary complications among patients undergoing noncardiothoracic surgery ranges from 2-19%. Postoperative pulmonary complications affect 10-30% of patients who require general anesthesia, and they can be more hazardous than a thromboembolic phenomenon, infectious complications.…”

Section: Introductionmentioning

confidence: 99%

Assessing the accuracy of the Revised Cardiac Risk Index compared to the American Society of Anaesthesiologists physical status classification in predicting Pulmonary and Cardiac complications among non-cardiothoracic surgery patients at Muhimbili National Hospital

Khamisi,

Chrisant,

Muhamba

et al. 2023

Preprint

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Background The Revised Cardiac Risk Index (RCRI) and the American Society of Anaesthesiologists (ASA-PS) classification system are two commonly used tools for preoperative risk assessment. This study aimed to assess the accuracy of RCRI compared to the ASA-PS classification system in preoperative risk assessment for pulmonary and cardiac problems among non-cardiothoracic surgery patients admitted at Muhimbili National Hospital (MNH).Methods This was a prospective cross-sectional study design conducted from August 2022 to April 2023 among 184 patients of 18 years and above admitted at MNH for elective non-cardiothoracic surgery. Data Analysis was conducted using STATA software version 16. Means and standard deviations were used to summarize continuous data. Frequencies and percentages were used to summarize categorical data. The logistic regression and ROC curve analysis were used to determine the correlation between variables.Results The majority of patients (43.3%) had an RCRI score of 1 point, and 39.9% were classified as ASA class 1. Patients in ASA classes 3 and 4 had higher odds of developing cardiac and pulmonary complications (AUC = 0.75 and 0.77, respectively). Patients with an RCRI score of 2 or ≥ 3 points were also more likely to experience cardiac and pulmonary complications (AUC = 0.73 and 0.72, respectively). There was no significant difference in the predictive ability of the two tools. Both RCRI and ASA-PS classification systems were equally effective in predicting these complications.Conclusion Both the RCRI and the ASA-PS classification system demonstrated good predictive ability for cardiac and pulmonary complications among patients undergoing non-cardiothoracic surgery.

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Stress echocardiography: the long and winding road from meta-analysis to bedside

Picano

2005

Int J Cardiovasc Imaging

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In response to the article by Noguchi et al. (Int. J. Cardiovascular Imaging 21,[189][190][191][192][193][194][195][196][197][198][199][200][201][202][203][204][205][206][207] In this issue, Noguchi et al. perform yet another meta-analysis in order to address the issue of which test is better for stress echocardiography [1]. The subject is an important one, and the authors meritoriously go through an extensive, 20-years long journey across the stress echo literature to reach some evidence-based conclusions: exercise is not so bad, dobutamine is similar to exercise, and dipyridamole is similar to dobutamine.Yet, the numbers should have a clinical rationale behind them and the quality score that the Authors assigned to the papers (on the basis of methodological criteria) misses some important points. Firstly, any meta-analysis has the inherent 'bouillabaisse' bias. You put together many different fishes, and a rotten fish is enough to compromise the quality of the overall work. In addition, here the same fish is sometimes multiplied in the literature -and some patients from some centres are certainly represented more than once in different papers coming from the same Institution and included in the meta-analysis.Secondly, it has been shown, confirmed and reconfirmed over time that -for pharmacological stress echo -the sensitivity mirrors the dose [3,4]. With dipyridamole [5], dobutamine [6] and adenosine [7], the sensitivity increases with higher doses and with atropine co-administration. The high dose dipyridamole protocol together with atropine, is considered to be state-of-the art and it is recommended by 8-years old guidelines [8]. Yet, Noguchi et al. pool data of standard dose [9] with high dose[10] and high dose plus atropine [11]. Not surprisingly, vasodilator stress echo sensitivity will suffer. It is also interesting that the best results were obtained by the least used stress, such as pacingstress echo or even pacing trans-oesophageal stress echo. The less feasible the test, the more distant from the real world, the best the published results mirroring initial experience from selected patients series in highly academic-oriented environment.When statistical data are tempered with clinical insight and common sense the conclusions of the data can be more realistically described. Twenty-five years of experience show that stress echo results have a satisfactory diagnostic accuracy with a variety of physical (exercise), pharmacological (dobutamine and dipyridamole) and electrical stressors (pacingwhich can be today administered non-invasively in patients with permanent pacemaker). Stress echo sensitivity is critically dependent on dose with pharmacological stress. Particularly for what concerns vasodilators, only studies with high dose plus atropine [11] or accelerated high dose [12] should be compared for diagnostic purposes. Taking into account these data, it comes out that:1. The specificity is highest for dipyridamole when compared to exercise and dobutamineas shown by meta-analysis considering only head-to...

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Perioperative risk stratification in non cardiac surgery: role of pharmacological stress echocardiography

Cited by 7 publications

References 56 publications

Position Statement on Indications of Echocardiography in Adults - 2019

Position Statement on Indications of Echocardiography in Adults - 2019

Assessing the accuracy of the Revised Cardiac Risk Index compared to the American Society of Anaesthesiologists physical status classification in predicting Pulmonary and Cardiac complications among non-cardiothoracic surgery patients at Muhimbili National Hospital

Stress echocardiography: the long and winding road from meta-analysis to bedside

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