STUDY THE CLINICAL VALUEOF PRE-OPERATIVE TRANSTHORACIC ECHOCARDIOGRAPHYAND ADHERENCETO INDICATIONS BY RECENT EVIDENCE-BASED GUIDELINESFOR EVALUATING PATIENTS UNDERGOING NON-CARDIACSURGERY

Abstract

Background: The pre-operative non-invasive testing aims at providing information on three cardiac risk markers: LV dysfunction, myocardial ischemia, and heart valve abnormalities, all major determinants of adverse post-operative outcome. One of these non-invasive testing is resting TTE. The aim of this study:The aim of this study is to identify whether requested transthoracic echocardiography (TTE) for patients undergoing non -cardiac surgery as a part of pre-operative assessment were indicated according to current published guidelines or not .Another aim is to detect the clinical impact of this pre-operative TTE on the decision-making and management. Methods: This study was conducted at Kasr Al Aini teaching-hospital, Cairo University, from January 2013 to January 2014, and included 125 randomly selected patients recommended for non-cardiac surgery of both gender (89 males and 36 females), with age between 18-86 years,admitted or presented to our hospital for non-cardiac surgery.TTE was done for each of our subjects after clinical evaluation , electrocardiogram , chest X-ray and routine lab ; these TTEs were analyzed according to 2009ESC guidelines, from view of indications of TTE and TTE findings. Results: 27 subjects had class I indication for pre-operative TTE with 100%of significant TTE findings(27 subjects with 20 moderate/severe valvular lesion, 13 LV systolic dysfunction, 22LV diastolic dysfunction (grade II and III) and 9 ischemic evidence),13 subjects had class IIa indication for pre-operative TTE with 100%of significant TTE findings( 13 subjects with 9 moderate/severe valvular lesion, 3 LV systolic dysfunction, 11 LV diastolic dysfunction and 4 ischemic evidence ) and85 subjects with class III indication for pre-operative TTE with91.7% of significant TTE findings (78 subjects with 44 moderate/severe valvular lesion, 20 systolic dysfunction, 72 diastolic dysfunction and 27 ischemic evidence). Conclusion: In conclusion, the pre-operative TTE examinations for not indicated patients can detect significant findings in the form of LV systolic dysfunction, LV diastolic dysfunction, moderate to severe valvular lesions and regional wall motion abnormality.Regardless of age and type of operation, the pre-operative TTE examination was not associated with improved hospital stay. Keywords: Pre-operative assessment - TTE – Non-cardiac operation - LV dysfunction - Myocardial ischemia –valvular heart disease