入院时常规使用对比剂进行经胸超声心动图检查可降低指数入院期间重复行超声心动图检查的比率。
Routine Use of Contrast on Admission Transthoracic Echocardiography for Heart Failure Reduces the Rate of Repeat Echocardiography during Index Admission.
机构信息
Georgia Institute of Technology, Atlanta, Georgia; Piedmont Heart Institute, Atlanta, Georgia.
Piedmont Heart Institute, Atlanta, Georgia.
出版信息
J Am Soc Echocardiogr. 2021 Dec;34(12):1253-1261.e4. doi: 10.1016/j.echo.2021.07.008. Epub 2021 Jul 18.
BACKGROUND
The authors retrospectively evaluated the impact of ultrasound enhancing agent (UEA) use in the first transthoracic echocardiographic (TTE) examination, regardless of baseline image quality, on the number of repeat TTEs and length of stay (LOS) during a heart failure (HF) admission.
METHODS
There were 9,115 HF admissions associated with admission TTE examinations over a 4-year period (5,337 men; mean age, 67.6 ± 15.0 years). Patients were grouped into those who received UEAs (contrast group) in the first TTE study and those who did not (noncontrast group). Repeat TTE examinations were classified as justified if performed for concrete clinical indications during hospitalization.
RESULTS
In the 9,115 admissions for HF (5,600 in the contrast group, 3,515 in the noncontrast group), 927 patients underwent repeat TTE studies (505 in the contrast group, 422 in the noncontrast group), which were considered justified in 823 patients. Of the 104 patients who underwent unjustified repeat TTE studies, 80 (76.7%) belonged to the noncontrast group and 24 to the contrast group. Also, UEA use increased from 50.4% in 2014 to 74.3%, and the rate of unjustified repeat studies decreased from 1.3% to 0.9%. The rates of unjustified repeat TTE imaging were 2.3% and 0.4% (in the noncontrast and contrast groups, respectively), and patients in the contrast group were less likely to undergo unjustified repeat examinations (odds ratio, 0.18; 95% CI, 0.12-0.29; P < .0001). The mean LOS was significantly lower in the contrast group (9.5 ± 10.5 vs 11.1 ± 13.7 days). The use of UEA in the first TTE study was also associated with reduced LOS (linear regression, β = -0.47, P = .036), with 20% lower odds for odds of prolonged (>6 days) LOS.
CONCLUSIONS
The routine use of UEA in the first TTE examination for HF irrespective of image quality is associated with reduced unjustified repeat TTE testing and may reduce LOS during an index HF admission.
背景
作者回顾性评估了在首次经胸超声心动图（TTE）检查中使用超声增强剂（UEA）的影响，无论基线图像质量如何，这对心力衰竭（HF）入院期间的重复 TTE 检查次数和住院时间（LOS）的影响。
方法
在 4 年期间，共有 9115 例 HF 入院患者接受了入院 TTE 检查（5337 名男性；平均年龄 67.6±15.0 岁）。患者分为首次 TTE 研究中使用 UEA 的患者（对比组）和未使用 UEA 的患者（非对比组）。如果在住院期间有具体的临床指征，则将重复 TTE 检查归类为合理。
结果
在 9115 例 HF 入院患者中（5600 例在对比组，3515 例在非对比组），927 例患者进行了重复 TTE 检查（505 例在对比组，422 例在非对比组），其中 823 例被认为是合理的。在进行了不必要的重复 TTE 研究的 104 例患者中，有 80 例（76.7%）来自非对比组，24 例来自对比组。此外，UEA 的使用率从 2014 年的 50.4%上升至 74.3%，不合理重复研究的比例从 1.3%下降至 0.9%。不必要的重复 TTE 成像的发生率分别为 2.3%和 0.4%（在非对比组和对比组中），且接受不必要重复检查的患者比例在对比组中较低（比值比，0.18；95%CI，0.12-0.29；P<0.0001）。对比组的平均 LOS 明显较低（9.5±10.5 天 vs 11.1±13.7 天）。首次 TTE 检查中使用 UEA 也与 LOS 缩短相关（线性回归，β=-0.47，P=0.036），OR 降低 20%，即发生较长（>6 天） LOS 的几率降低。
结论
无论图像质量如何，HF 患者首次 TTE 检查中常规使用 UEA 可减少不必要的重复 TTE 检查，并可能缩短指数 HF 入院期间的 LOS。
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