Like many well-designed, prospective blinded studies, this one raises as many questions as it answers. Of the 500 patients enrolled, 33 patients were removed. Two patients had inadequate studies, and 31 patients were determined to have a history of significant cardiovascular disease, or the current hospitalization represented an acute cardiovascular event. Fifty-two of 467 patients were unblinded for the incidental findings of a “critical” cardiovascular abnormality. Critical lesions were prospectively identified as severe valvular insufficiency or stenosis, right ventricular (RV) pressure ≥ 50 mm Hg, left ventricular (LV) ejection fraction ≤ 35%, pericardial effusion causing hemodynamic compromise, valvular vegetations, LV thrombus, or aortic dissection. It is open to speculation if these critical abnormalities would have been discovered eventually or if preemptively finding them impacted patient outcome. It is also unknown whether the findings in the 130 patients with cardiac abnormalities that were not revealed to the treating physicians would have changed management or outcome. Interestingly, there are no comparable studies measuring the incidence of cardiac abnormalities in surgical ICU patients, those admitted to a non-ICU hospital ward, or the general population.