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J Thorac Cardiovasc Surg 2003;126:944-946
© 2003 The American Association for Thoracic Surgery

Editorial

Finding our way from the heart to the head

Ralph J. Petrucci, EdD*,a

a MCP Hahnemann University, Philadelphia, Pa, USA

Received for publication February 19, 2003; accepted for publication March 4, 2003.

* Address for reprints: Ralph J. Petrucci, EdD, MCP Hahnemann University, Hospital North Tower, 203 N Broad St, Mail Stop 115, Philadelphia, PA 19102-1192, USA
Ralph.Petrucci@drexel.edu

The first 20% of the full text of this article appears below.


Dr Petrucci


We have all had this experience. The patient sits before us accompanied by a family member during a preoperative office visit, denying any cognitive problems after a significant cardiac event. The gestures from the family member in the background of the office indicate something quite different. "Oh no, I'm doing fine," the patient says, despite occupational, financial, social, and sexual dysfunction. However, when we ask about the children and grandchildren, the room suddenly becomes humid. So, what is all the concern about any relationship between the head and the heart? According to our patient, there is not any.

If we are to explain this cardiocognitive connection, much will depend on further exploration of physiologic parameters and not just new surgical techniques. Neuropsychology can further the contribution to cardiothoracic surgery in this area. Balancing variable selection, design, statistical manipulation, and assessment of the relevant outcome is a tough accomplishment. The current article by Taggart and colleagues1 does just that, isolating a variable, blood gas levels, to assess the relationship between preoperative and postoperative cognitive dysfunction.

Use of parametric statistics over incident reports, frequency, or descriptive statistics alone carries more power in assessing clinical outcome and applicability. Parametric analyses with an established confidence level at a P value of less than .05 or less than .01 will assist interpretation. Most medical research accepts results at a P value of less than .05. The use of standardized scores, z scores, allows researchers to compare measures over time.2-4

Investigators usually establish an interpretation of clinically meaningful change a priori. The use of standardized scores, patient self-reports, and collateral data . . . [Full Text of this Article]






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