Routine Echocardiography Before Vascular Surgery?

In most predictive models, history of symptomatic heart failure is an independent risk factor for complications after noncardiac surgery (JW Gen Med Sep 17 1999). But, what about asymptomatic left ventricular (LV) dysfunction?

Dutch researchers performed routine preoperative echocardiography in 1005 consecutive patients who were scheduled for elective vascular surgery (carotid, abdominal aorta, or lower extremity). Half the patients had normal LV function, 21% had asymptomatic isolated diastolic dysfunction, 19% had asymptomatic systolic dysfunction (ejection fraction <50%, with or without diastolic dysfunction), and 10% had symptomatic heart failure.

In multivariate analysis adjusted for other standard perioperative risk factors, asymptomati…