We agree completely with the comment by Halm that rest transthoracic echocardiography does not facilitate risk stratification of patients undergoing noncardiac surgery. Our finding that plain echocardiography was the most commonly ordered preoperative test raises concern about inappropriate utilization. However, as discussed in our article,1 we do not know whether any of these tests was ordered for reasons other than to determine perioperative risk stratification. It is possible, for example, that some of the preoperative echocardiograms in our study were used for assessment of long-term health issues. Despite this limitation, the high frequency of preoperative plain echocardiography raises concern that this test is being inappropriately used for perioperative cardiac risk assessment.
Devereaux PJ, Ghali WA, Guyatt GH. Assessing Cardiac Risk Assessment. Arch Intern Med. 1999;159(18):2226-2227. doi: