1. Lead author No. patients Patient groupPrimary outcomesPositive ResultsStatistical significance Rohde 1 570Elective major non-cardiac surgery Primary cardiac arrest MR Cardiogenic APO VF Sustained CHB LV systolic dysfunction predicted POC Mod/severe LVH predicted post- operative MI Aortic stenosis >40mmHg predicted POC Abnormal pre-operative echo predicted POC OR 2.0 [CI 1.0-4.5] OR 3.1 [CI 1.1-8.3] OR 6.8 [CI 1.3-31], p=0.01 NPV 97% Takase 2 53Elective non- vascular surgery. Patients with suspected IHD Cardiac death MI Unstable angina APO LV systolic dysfunction associated with post-operative APO p=0.007 Kontos 3 87Elective non- cardiac surgery Cardiac death MI Revascularisation before surgery LVEF <50% predicted POCSensitivity 86% Specificity 81% PPV 43% NPV 97% Rossi 4 110Elective peripheral vascular surgery Cardiac death MI at one year LVEF <40% predicted late events Sensitivity 53% Specificity 91% PPV 53% NPV 93% Halm 5 339Elective non- cardiac surgery. Patients with known or suspected IHD. Ischaemia VT CCF LVEF <40% predicted combined POC LV dysfunction predicted combined POC OR 2.5 [CI 1.2-5.0] OR 1.3, [CI 1.0-1.7] Devaux 6 63Elective adrenalectomy Haemodynamic instability in intra- and post-operative period Abnormal TTE correlated with post-operative CCF p=0.06 Table 1

2. 1 Rohde LE, Polanczyk CA, Goldman L et al. Risk stratification of Patients Undergoing Peripheral Vascular Revascularization by Combing Resting and Dipyridamole Echocardiography. Am J Cardiol 2001;87:505-509 2 Takase B, Younis LT, Byers SL et al. Comparative prognostic value of clinical risk indexes, resting two-dimensional echocardiography, and dipyridamole stress thallium-201 myocardial imaging for perioperative cardiac events in major nonvascular surgery patients. Am Heart J. 1993; 126 (5) 1099-1106 3 Kontos MC, Brath LK, Akosah KO et al. Cardiac complications in noncardiac surgery: Relative value of resting two-dimensional echocardiography and dipyridamole thallium imaging. Am Heart J 1996;132:559-66 4 Rossi E, Citterio F, Vescio MF et al. Risk Stratification of Patients Undergoing Peripheral Vascular Revascularisation by Combined Resting and Dipyridamole Thallium Imaging. Am J Cardiol 1998; 82 (3), p306-310 5 Halm EA, Browner WS, Tubau JF et al. Echocardiography for Assessing Cardiac Risk in Patients Having Noncardiac Surgery. Annals of Internal Medicine 1996 126;6:433-441. 6 Devaux B, Lentschener C, Jude N et al. Predictive value of preoperative Transthoracic echocardiography in patients undergoing adenalectomy for phaeochromocytoma. Acta Anaestheiol Scand 2004; 48: 711-715 All figures quoted are for multivariate analyses of the predictive effect of transthoracic echocardiography. IHD = Ischaemic heart disease. MR = Mitral Regurgitation. APO = Acute pulmonary oedema. VF = Ventricular fibrillation. CHB = Complete heart block. MI = Myocardial infarction. VT = Ventricular tachycardia. CCF = Congestive cardiac failure. LV = Left ventricular. LVH = Left Ventricular Hypertrophy. LVEF = Left Ventricular Ejection Fraction. POC = Post-operative complication. OR = Odds ratio. CI = Confidence Interval. PPV = Positive Predictive Value. NPV = Negative predictive value