Before any operation requiring general anaesthetic, an anaesthetist may request a preoperative echocardiogram. They will mainly be interested in your ventricular function – how well your ventricles contract and relax. The most widely accepted measure of performance is the left ventricular ejection fraction* – what percentage of blood your left ventricle is pumping out of your aorta in a single beat.
If a problem is found with your heart's function, you may not be able to undergo the planned (and perhaps most effective) procedure.
Systolic and diastolic (i.e. contracting and relaxing) function are interdependent, and diastolic function especially can be augmented to a certain degree by an active and healthy lifestyle (see Brenner, Apstein & Saupe’s 2001 study), as, incidentally, can arterial compliance (Gates et al., 2003).
This assessment may be requested for operations ranging from hip replacements to vascular surgery, and is particularly likely if there is suspicion of impaired function, raised right heart pressures, or valvular heart disease. Patients with a known history of ischaemic heart disease (particularly a previous myocardial infarction), recent ECG changes or even atrial fibrillation are also at increased likelihood of receiving a referral for preoperative echo.
Patients about to undergo a course of chemotherapy or certain cancer drugs (such as Trastuzumab/Herceptin) are also commonly referred for a ‘baseline’ echocardiogram, as well as a follow-up scan during and after their cancer treatment.
* Ejection fraction (EF) is considered by many prominent scientists to be an outdated and unrepresentative measure of left ventricular performance. It seems likely that EF% will eventually be superseded by strain and strain rate acquired from tissue Doppler imaging or, in time, speckle tracking. Ejection fraction is so widely used and understood, however, that it is unlikely to be replaced imminently.
Brenner, D., Apstein, C., Saupe, K. (2001). Exercise Training Attenuates Age-Associated Diastolic Dysfunction in Rats. Circulation (104), 2.
Gates, P., Tanaka, H., Graves, J., Seals, D. (2003). Left ventricular structure and diastolic function with human ageing. Relation to habitual exercise and arterial stiffness. Eur Heart Journal, 24:2213-20.