In the current issue of CHEST (see page 1370), the report by Bossone and colleagues revealed a high incidence (36%) of occult cardiac abnormalities utilizing blinded comprehensive two-dimensional transthoracic echocardiography (TTE) and Doppler echocardiographic evaluation in 500 consecutive patients admitted to the University of Michigan medical ICU for noncardiac reasons. All of the TTE studies were obtained within 18 h of ICU admission. Approximately 14% of patients had two or more cardiac abnormalities identified. Only patients with a finding of pulmonary hypertension on TTE had a longer length of ICU stay, but there was no difference in mortality between patients with a positive finding on TTE and those with normal study findings. Patients with sepsis or liver failure as an ICU admitting diagnosis had a lower incidence of TTE findings, while patients with neurologic or hypertensive emergencies had a higher prevalence of abnormalities.