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Daily Medical Update
Preoperative cardiac testing
Monday, September 14, 2026
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🔬 Practice-Changing Findings
Evidence from RCTs and meta-analyses published in the
last 12 months.
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Journal of cardiovascular computed tomography (2025) - Meta-Analysis, Systematic Review
Key Findings
- Obstructive stenosis on CCTA was associated with higher short-term postoperative MACE odds than nonobstructive or normal findings (OR 3.94; 95% CI 1.63-9.54).
- Severe CACS (≥400) had odds ratios of 2.29 and 5.45 for short- and long-term MACE, respectively; both tests had high negative predictive value but moderate positive predictive value.
📋 Practice Implication: Use CCTA/CACS selectively when coronary burden could change perioperative planning; a negative result may be more useful for ruling out MACE than a positive result is for confirming it.
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International journal of surgery (London, England) (2025) - Meta-Analysis, Systematic Review
Key Findings
- EPO combined with autologous blood donation reduced transfusion rates versus placebo (log OR -6.34; 95% CrI -12.86 to -0.16).
- Combined iron, EPO, folic acid, and vitamin B12 treatment showed a statistically superior blood-loss outcome versus placebo (MD 126.33 mL; 95% CrI 23.27-229.49), while no intervention significantly reduced transfusion volume versus placebo.
📋 Practice Implication: Build anemia optimization around EPO plus autologous blood donation when reducing transfusion rates is the immediate goal, while recognizing that no regimen clearly lowered transfusion volume.
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BMC cardiovascular disorders (2026) - Meta-Analysis, Systematic Review
Key Findings
- Perioperative amiodarone reduced POAF incidence (OR 0.39; 95% CI 0.31-0.49).
- Amiodarone was associated with a 1.33-day shorter hospital stay and fewer cerebrovascular accidents (OR 0.59), but increased bradycardia risk (OR 2.33); mortality, heart block, and hypotension did not differ significantly.
📋 Practice Implication: Consider perioperative amiodarone prophylaxis for selected cardiac-surgery patients using an institutionally defined timing and route, with bradycardia monitoring because dose alone did not explain benefit.
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Interdisciplinary cardiovascular and thoracic surgery (2026) - Meta-Analysis, Systematic Review
Key Findings
- Preoperative left atrial reservoir strain was lower in patients who developed POAF than in those who did not (SMD -2.37; 95% CI -3.87 to -0.88).
- Conduit and contraction strain were also lower with POAF, while a reservoir-strain threshold of 22-25% yielded AUC 0.69, sensitivity 0.713, and specificity 0.679.
📋 Practice Implication: Use reduced preoperative left atrial strain as an adjunct to identify patients who may merit closer POAF surveillance, but do not treat the 22-25% threshold as a stand-alone diagnostic test.
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Journal of the American Heart Association (2026) - Multicenter Study, Randomized Controlled Trial
Key Findings
- Organ dysfunction or death within 48 hours occurred in 434 of 1,394 patients (31.1%).
- The preoperative model had AUC 0.644, which improved to 0.773 after adding ICU-admission SOFA score and cardiopulmonary bypass duration.
📋 Practice Implication: Combine baseline vulnerability measures with early ICU physiology for postoperative resource planning, because presurgical variables alone had substantially weaker discrimination for organ dysfunction or death.
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Summary
Across five high-significance studies, preoperative coronary imaging, anemia optimization, left atrial strain, and vulnerability assessment improved risk stratification or perioperative outcomes in selected cardiac and noncardiac surgery populations. CCTA/CACS identified postoperative MACE risk, amiodarone reduced POAF with more bradycardia, and adding immediate postoperative physiology improved prediction of early organ dysfunction or death.
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