Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor
To the Editor: In their observational study,
Dr Polanczyk and colleagues1 found an increased
incidence of congestive heart failure (CHF) in patients receiving perioperative
right heart catheterization (RHC) for noncardiac surgery. They state that
"diagnosis of perioperative CHF was obtained from progress notes recorded
by clinicians involved in the patients' care." They do not indicate, however,
whether the diagnosis of CHF was made in light of data obtained from RHC.
It is possible that an elevated pulmonary capillary wedge pressure (PCWP)
would have resulted in a diagnosis of CHF and thus resulted in medical therapy,
which would then have been classified as a complication. If a certain level
of postoperative PCWP was diagnostic of CHF, monitored patients who received
RHC would be more likely to have this so-called complication. It is common
knowledge that the clinical examination is less sensitive than RHC at detecting
an abnormally high PCWP.
Myla S. Does Right Heart Catheterization Prevent Perioperative Complications?. JAMA. 2001;286(23):2940-2941. doi:10.1001/jama.286.23.2940