title: 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.
authors.affiliation: Department of Medical Imaging Service, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. ahm35799@hotmail.com
authors.forename: Ahmed
authors.initials: A
authors.lastname: Fathala
authors.forename: Walid
authors.initials: W
authors.lastname: Hassan
mesh_terms: D000790:Angiocardiography; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D004452:Echocardiography; D017558:Elective Surgical Procedures; D004632:Emergency Medical Services; D005080:Exercise Test; D017408:Guidelines as Topic; D006801:Humans; D008279:Magnetic Resonance Imaging; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods*; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016277:Ventricular Function, Left