Role of multimodality cardiac imaging in preoperative cardiovascular evaluation before noncardiac surgery

Abstract

The preoperative cardiac assessment of patients undergoing noncardiac surgery is common in the daily practice of medical consultants, anesthesiologists, and surgeons. The number of patients undergoing noncardiac surgery worldwide is increasing. Currently, there are several noninvasive diagnostic tests available for preoperative evaluation. Both nuclear cardiology with myocardial perfusion single photon emission computed tomography (SPECT) and stress echocardiography are well-established techniques for preoperative cardiac evaluation. Recently, some studies demonstrated that both coronary angiography by gated multidetector computed tomography and stress cardiac magnetic resonance might potentially play a role in preoperative evaluation as well, but more studies are needed to assess the role of these new modalities in preoperative risk stratification. A common question that arises in preoperative evaluation is if further preoperative testing is needed, which preoperative test should be used. The preferred stress test is the exercise electrocardiogram (ECG). Stress imaging with exercise or pharmacologic stress agents is to be considered in patients with abnormal rest ECG or patients who are unable to exercise. After reviewing this article, the reader should develop an understanding of the following: (1) the magnitude of the cardiac preoperative morbidity and mortality, (2) how to select a patient for further preoperative testing, (3) currently available noninvasive cardiac testing for the detection of coronary artery disease and assessment of left ventricular function, and (4) an approach to select the most appropriate noninvasive cardiac test, if needed.

The utility and prognostic value of dipyridamole technetium-99m sestamibi myocardial perfusion imaging SPECT in predicting perioperative cardiac events following non-cardiac surgery

“…1 Although, the value of medical consultation in preoperative risk evaluation seems to be imperative, investigations have nevertheless questioned the effectiveness of preoperative assessment. 2 Therefore, the development of an accurate and practical test that will provide timely assistance to surgeons, cardiologists, anesthesiologists and patients is necessary.…”

Approach to Noncardiac Surgery in a Cardiac Patient: Do We Need to Modify?

“…However, if patients are unable to perform adequate exercise, pharmacological stress with adenosine, dipyridamole, or dobutamine stress myocardial perfusion scintigraphy with single photon computed tomography or dobutamine echocardiography are recommended. 25,26 But stress myocardial perfusion scintigraphy and dobutamine echocardiography have several limitations such as lack of facility, limited expertise, nondiagnostic or nonconclusive results, and expense. It is here that coronary computed tomography angiography (CCTA) with multidetector computed tomography becomes useful as CCTA has demonstrated excellent delineation of coronary artery stenosis.…”

“…Demographic and clinical characteristics were similar in both groups, except for systolic arterial pulmonary pressure in the HES group v 25 mmHg [extremes [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] in the NaCl group; p = 0.017). We found a moderate but significant decrease in additional fluids mandatory to maintain hemodynamic stability and adequate functioning during CPB in the HES group (Table 1).…”

2014 Korean Guidelines for Appropriate Utilization of Cardiovascular Magnetic Resonance Imaging: A Joint Report of the Korean Society of Cardiology and the Korean Society of Radiology

“…Therefore, CMR has recently been used more frequently in clinical practice as a preoperative test for myocardial viability and perfusion, valvular heart disease, cardiomyopathy, and congenital heart disease. 82) In particular, in patients who showed a negative stress perfusion CMR examination, the probability of not experiencing cardiac death or a nonfatal myocardial infarction for at least 3 years is as high as 99.2%, indicating a very low likelihood of future cardiovascular disease. 37) Additionally, in meta-analysis of 21 studies that observed a total of 1233 subjects, stress perfusion CMR examination scored high on its ability to assess obstructive CAD with a sensitivity of 84% (range, 44-93%) and a specificity of 80% (range, 60-100%); therefore, CMR is thought to be very useful in the preoperative assessment of CAD.…”