Role of Dobutamine Stress Echocardiography in the Evaluation of Patients Undergoing Noncardiac Surgeries in the Contemporary Era

Dear Editor, I have read with interest the excellent article “Role of dobutamine stress echocardiography in the evaluation of patients undergoing noncardiac surgeries in the contemporary era” by Chaudhary et al. and would like to congratulate the authors for the same.[1] Chaudhary et al. have mentioned “Lee’s Score” in 30 places and “Revised Cardiac Risk Index or Lee’s Score” in three places in their article.[1] I have encountered several confusing terms: “Lee’s Score,” “Lee’s Criteria,” “Lee’s Index,” “Lee’s Cardiac Score,” “Revised Cardiac Risk Index (Lee Criteria),” and “Cardiac Risk Index,” – being used interchangeably and synonymously in many articles and related websites in the domain of cardiac risk assessment in noncardiac surgical procedures, which if addressed, in my opinion can increase the impactfulness of the article. These terms do not appear to have the rigor and backing of guideline-writing committees, and any effort toward a global consensus would be a welcome move. Hereunder I have proposed a methodical basis for coining such terms using Goldman Lee’s article as an example[2] for critical appraisal by guideline writing committees [Figure 1].Figure 1: The relation between criteria, score, index, and Revised Cardiac Risk Index, using Goldman Lee’s article in circulation as an example[ 2 ]Patients undergoing noncardiac surgery are at risk of major cardiovascular complications. Several groups developed tools to stratify patients with regard to their risk of perioperative cardiovascular complications. The first landmark article “Multifactorial index of cardiac risk in noncardiac surgical procedures” was published in 1977 in the New England Journal of Medicine by the Goldman Lee’s group.[3] In this article, there are eight authors – with Goldman Lee being the lead author – the index is usually referred to as “Goldman’s Original Cardiac Risk Index.” A decade later in 1986, Detsky et al. published an article entitled “Cardiac assessment for patients undergoing noncardiac surgery: A multifactorial clinical risk index” in the journal of Archives of Internal Medicine.[4] This article formed the basis for the modified version of “Goldman’s Original Cardiac Risk Index,” which later on came to be known as “Detsky’s Modified Cardiac Risk Index.”[4,5] About a decade later in 1999, Goldman Lee’s group came up with another landmark paper titled “Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery” in Circulation, and the Index described in the article being referred to as “Revised Cardiac Risk Index” by the authors.[2] In this article, there are 13 authors, with Goldman Lee being the lead author in both the landmark articles.[2,3] These papers formed the basis for the multifactorial approach to assessing the cardiac risk of noncardiac surgery and for any common clinical problem. Goldman Lee and Allan Steven Detsky et al. are the lead researchers in these studies.[2,4,5] In my opinion, the regulatory guideline writing committees of the American College of Cardiology, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, American Society of Preventive Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, Society of Thoracic Surgeons, European Society of Cardiology, European Atherosclerosis Society, European Association of Cardiovascular Imaging, European Heart Society, European Association for Cardio-Thoracic Surgery, Canadian Cardiovascular Society, and Cardiological Society of India should come up with a consensus to regulate these terms. This endeavor will prevent the inappropriate usage of terms from mushrooming and mutating and help researchers navigate these high seas. Authors’ contributions This manuscript has only one author who is responsible for the entire work. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.