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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.

The pertinent . . . [Full Text of this Article]

RELATED ARTICLE

Right Heart Catheterization and Cardiac Complications in Patients Undergoing Noncardiac Surgery: An Observational Study
Carisi A. Polanczyk, Luis E. Rohde, Lee Goldman, E. Francis Cook, Eric J. Thomas, Edward R. Marcantonio, Carol M. Mangione, and Thomas H. Lee
JAMA. 2001;286(3):309-314.
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