Echocardiography is a widely available diagnostic procedure with minimal patient risk.  However, there are concerns that echocardiography may be overused relative to clinical need.  To this end, appropriate use criteria have been developed to support the effective and efficient use of echocardiography. However, the clinical impact of echocardiography in relation to appropriateness has not been described.

In this study from a single academic center, the appropriateness and clinical impact of 535 consecutive transthoracic echocardiograms (TTEs) was determined from chart review. Chart reviewers rated TTE appropriateness based on 2011 criteria and were blinded to the results of the echo and subsequent clinical course.  Clinical impact was defined by categories of active change in care, continuation of current care, or no change in care.  Overall, 91.8% of TTE were classified as appropriate, 4.3% as inappropriate and 3.9% were rated as uncertain appropriateness. Overall, 31.8% of echocardiograms resulted in a change in care, 46.9% led to continuation of same management and 21.3% led to no change. There was no difference in the proportion of appropriate and inappropriate TTEs that led to a change in clinical management (32.2% vs. 21.7%, p=0.29).

Conclusions: In this retrospective study, the majority of TTEs were appropriate and a similar proportion of appropriate and inappropriate TTEs led to a change in clinical management. However, diagnostic studies are often important for their ability to refute a diagnosis in the evaluation of patients and this relationship may be underappreciated in this study.  Continued refinement, evaluation, and application of the appropriate use criteria are needed to optimize patient selection in the use of diagnostic tests.

• Matulevicius SA, Rohatgi A, Das SR, et al. Appropriate use and clinical impact of transthoracic echocardiography. JAMA internal medicine. 2013;173:1600-1607