经胸超声心动图适宜性与超声心动图结果的关系。

Association Between Transthoracic Echocardiography Appropriateness and Echocardiographic Findings.

机构信息

Women's College Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.

Women's College Hospital, Toronto, Ontario, Canada.

出版信息

J Am Soc Echocardiogr. 2019 May;32(5):667-673.e4. doi: 10.1016/j.echo.2019.01.004. Epub 2019 Mar 4.

DOI:10.1016/j.echo.2019.01.004

PMID:30846322

Abstract

BACKGROUND

The association between appropriate use criteria and echocardiographic findings in patients with chronic cardiovascular diseases is unknown.

METHODS

As a substudy of the Echo WISELY (Will Inappropriate Scenarios for Echocardiography Lessen Significantly) trial, 9,230 transthoracic echocardiographic (TTE) examinations from six Ontario academic hospitals were linked to a registry of echocardiographic findings. The TTE studies were rated appropriate), rarely appropriate, or may be appropriate according to the 2011 appropriate use criteria. TTE findings of appropriately ordered examinations were compared with those of rarely appropriate examinations for specific disease subsets, including heart failure and valvular heart disease.

RESULTS

There were 7,574, 1,087, and 569 TTE examinations ordered for appropriate, rarely appropriate, and may be appropriate indications, and of the 7,574 appropriate studies, 6,399 were ordered for specific indications and 1,175 for general indications. TTE examinations ordered for general indications had lower rates of left ventricular dysfunction (19.6% vs 9.1%, P < .001) and moderate to severe aortic stenosis (15.5% vs 2.6%, P < .001). Of the 2,395 TTE examinations ordered for patients with heart failure, appropriately ordered studies were more likely to result in left ventricular segmental abnormality (37.0% vs 24.9%, P = .012) but similar rates of right ventricular dilatation (15.4% vs 14.7%, P = .79), right ventricular dysfunction (14.8% vs 11.3%, P = .22), and moderate to severe mitral regurgitation (12.1% vs 9.2%, P = .35). Of the 2,859 studies ordered to assess valvular heart disease, appropriately ordered studies were significantly more likely to find moderate to severe valvular pathology, including aortic stenosis (30.4% vs 24.6%, P = .008), aortic regurgitation (8.9% vs 1.6%, P < .001), mitral stenosis (6.7% vs 3.1%, P = .002), and mitral regurgitation (16.1% vs 6.1%, P < .001), but similar rates of tricuspid regurgitation (11.2% vs 13.0%, P = .60).

CONCLUSIONS

Overall, appropriately ordered TTE examinations for heart failure and valvular heart disease were significantly more likely to have abnormal findings than rarely appropriate examinations. TTE studies ordered for general indications had fewer, although still a significant proportion, of abnormalities compared with studies ordered for specific indications.

摘要

背景

慢性心血管疾病患者的适用标准与超声心动图结果之间的关系尚不清楚。

方法

作为 Echo WISELY（Will Inappropriate Scenarios for Echocardiography Lessen Significantly）试验的子研究，将来自安大略省 6 家学术医院的 9230 例经胸超声心动图（TTE）检查与超声心动图结果注册中心进行了关联。根据 2011 年的适用标准，TTE 研究被评为适当、很少适当或可能适当。对于特定疾病亚组，包括心力衰竭和瓣膜性心脏病，比较了适当顺序检查的 TTE 结果与很少适当检查的结果。

结果

有 7574、1087 和 569 次 TTE 检查分别用于适当、很少适当和可能适当的适应证，在 7574 次适当的研究中，6399 次用于特定适应证，1175 次用于一般适应证。用于一般适应证的 TTE 检查左心室功能障碍发生率较低（19.6% vs 9.1%，P<.001）和中度至重度主动脉瓣狭窄发生率较低（15.5% vs 2.6%，P<.001）。在 2395 次用于心力衰竭患者的 TTE 检查中，适当顺序的检查更有可能导致左心室节段性异常（37.0% vs 24.9%，P=.012），但右心室扩张率相似（15.4% vs 14.7%，P=.79），右心室功能障碍（14.8% vs 11.3%，P=.22）和中度至重度二尖瓣反流（12.1% vs 9.2%，P=.35）。在 2859 次用于评估瓣膜性心脏病的研究中，适当顺序的研究发现中度至重度瓣膜病变的可能性明显更高，包括主动脉瓣狭窄（30.4% vs 24.6%，P=.008），主动脉瓣反流（8.9% vs 1.6%，P<.001），二尖瓣狭窄（6.7% vs 3.1%，P=.002）和二尖瓣反流（16.1% vs 6.1%，P<.001），但三尖瓣反流率相似（11.2% vs 13.0%，P=.60）。