Thread by @ruthi_landau

#METS for cardiac risk stratification
➡️ decision making based on patients functional capacity (fitness)

@CUMCAnesthesia Grand Rounds

Actually poor correlation between patient self reported exercise capacity & objective testing results (R=0.31) or METS vs cardiac complications!

What about biomarkers for fitness?!!
➡️ Natriuretic peptides

1️⃣ Subjective fitness estimate (METS)
2️⃣ Standardized questionnaires
3️⃣ Exercise tests
4️⃣ Biomarkers
Combining all 4 in prospective study to predict post-op outcomes

➡️ subjective assessment by anesthesiologists was NOT predictive !!!

#METS
➡️ subjective assessment should be abandoned to predict cardiac complications

Fitness does not correlate with VO2 peak

But dominant effects are non cardiac & fitness predicts other complications (reap failure, infections)

#DASI to predict cardiac complications
➡️ threshold of 34 is predictive

@vmoitra @hastie_md @MayHuaMD

How should we optimize preoperatively the patient with #DASI < 34 ?!!

➡️ Improve VO2 max in the 2 weeks preceding surgery (if possible)