Preoperative Dobutamine Stress Echocardiography and Clinical Factors for Assessment of Cardiac Risk after Noncardiac Surgery

Authors' Reply

“…The perioperative event rates of patients with modified RCRI scores of $3 are higher than those of patients with lower modified RCRI scores (5.0% and 8.8% for normal and abnormal results on DSE, respectively, P = .293). 1 Additional analysis revealed that the postoperative mortal-ity rate of patients with modified RCRI scores of $3 and normal findings on DSE was reassuringly low at 1.3% (one of 80 patients). Therefore, our findings support guideline recommendations to consider DSE in patients with elevated RCRI scores if findings will change clinical management.…”

“…We thank Dr. Kaw for his questions related to our report, ''Preoperative Dobutamine Stress Echocardiography and Clinical Factors for Assessment of Cardiac Risk after Noncardiac Surgery.'' 1 The first question pertains to the circumstances under which perioperative clinicians should order dobutamine stress echocardiography (DSE). As outlined in Figure 1 in our report 1 and consistent with perioperative guidelines, we recommend preoperative DSE in patients with multiple cardiovascular risk factors who are undergoing intermediate-or high-risk noncardiac surgery if the findings on DSE will potentially change management.…”

“…1 The first question pertains to the circumstances under which perioperative clinicians should order dobutamine stress echocardiography (DSE). As outlined in Figure 1 in our report 1 and consistent with perioperative guidelines, we recommend preoperative DSE in patients with multiple cardiovascular risk factors who are undergoing intermediate-or high-risk noncardiac surgery if the findings on DSE will potentially change management. 2,3 In patients who do undergo preoperative DSE, ischemic threshold can provide a heart rate below which cardiac ischemia may be avoided during perioperative management.…”

“…In our study, we reported the incremental prognostic value of DSE when added to clinical variables. 1 This analysis did not consider resting or baseline echocardiographic findings. We performed another incremental analysis incorporating clinical variables, baseline wall motion score index, baseline left ventricular ejection fraction, peak stress wall motion score index, and peak stress left ventricular ejection fraction.…”

“…In a recent paper, Clemmensen et al 1 have applied left ventricular pressure strain-derived myocardial work (LVMW) indices in a cohort of cardiac amyloidosis (CA) patients and healthy controls, both at rest and during semisupine exercise. 1 The authors report that CA patients have significantly lower rest longitudinal strain (LS) along with lower LVMW and myocardial work efficiency compared with controls. In addition, during exercise, they present a lower improvement of LVMW mainly driven by apical regions and a significantly reduced energy exploitation (based on LS evaluation).…”