Abstract
To the Editor. —We agree with Drs Hostetler and Dunn that exercise stress tests are often of limited value in assessing the perioperative risk of patients with abdominal aortic aneurysms (AAAs).1Dipyridamole-thallium and other noninvasive tests clearly have a major role in assessing this risk. Measurement of ejection fraction, however, should not be used as the sole screening test to assess perioperative risk since the utility of this information varies with different studies and since it is unclear whether knowledge of the ejection fraction adds additional information beyond a thorough clinical assessment.2,3Recently, continuous 12-lead electrocardiographic monitoring to detect silent ischemic episodes in the perioperative period has also been useful in predicting ischemic events.4Hollenberg et al5identified five major clinical preoperative predictors of postoperative myocardial ischemia. These were (1) left ventricular hypertrophy by electrocardiogram; (2) history of hypertension; (3) diabetes mellitus; (4) coronary artery disease;
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