R. Davis*, S. Mylabathula, H. Kandy, D. Foster, N. Hurst

The Cardiology Clinic, East Maitland, Australia

Purpose: The authors aimed to study the reliability of an underutilised diagnostic strategy in high risk pre-op patients with functional limitations. Adverse peri-operative cardiac events continue to create a major burden on the health care system. Traditional non-invasive methods of risk assessment are limited, expensive and with restricted availability. Commonly, equivocal results are reported and an often unnecessary invasive cardiac procedure is performed, increasing both morbidity risk to the patient and health care cost.

Method: A total of 941 patients were prospectively enrolled from a single private facility from Feb 2013 to Feb 2013. Data was collected for patients referred for preoperative evaluation (n=64), mean age 68 +- 9.2 years of which 50% were male. Test was considered valid with an effective increase in heart rate (>85% of Max HR, WHO protocol) or a clinical endpoint. Outcomes were noted for immediate post-operative and three month follow-up.

Results: Demography showed known coronary artery disease (CAD) in 38.4% (24), high risk based on two or greater risk factors 79.6% (52), diabetes 25.6% (16) and right and left bundle branch block 17.3% (11). Conversely, 54.7% (35) stated that they had never undergone diagnostic cardiac risk assessment. Overall, 11.2% (7) resulted in angiography of which 9.6% (6) needed further cardiac management. Importantly, 89% (57) avoided potential diagnostic angiography. There were no adverse cardiac events during testing or in follow up period.

Conclusion: In high risk pre-op patients with functional limitations, suspine ergometry echocardiography consistently allowed accurate risk stratification.