The role of nuclear cardiology for preoperative risk assessment prior to noncardiac surgery.

: Preoperative risk assessment, before noncardiac surgery, aims to reduce mortality and morbidity, during the perioperative period. Cardiac risk could be minimised through treatment and stabilisation of the underlying disease, careful monitoring and prophylactic medications. However, cardiac complications, especially, ischemic events are still frequent causes of death during surgery and hospital recovery. A teamwork approach that involves cardiologist, anaesthesiologist and surgeon is required for optimal risk assessment and monitoring in the perioperative period. The incidence of coronary artery disease increases with age and with the presence of risk factors such as diabetes or hypertension. There is also a strong relation between coronary and vascular disease as they are part of the same pathophysiology and have common risk factors. Careful cardiac evaluation is essential when vascular surgery is planned. Clinical evaluation is the first step of preoperative risk assessment and allows the identification of low and high-risk patients. If there is absent or low cardiac risk, surgery may be carried out. In the presence of high-risk markers and if the surgery is elective, coronary arteriography should be considered before non-cardiac surgery. The information provided by non-invasive diagnostic testing is essential in those patients with an intermediate clinical risk for cardiac events. Concerning coronary artery disease, myocardial function and ischemic burden are strong prognostic markers and in this particular setting, nuclear cardiology can play an important role. The extent and localisation of ischemia is well defined by myocardial perfusion scintigraphy and ventricular function can be evaluated by radionuclide ventriculography or by gated perfusion studies.