Journal of the American Society of Echocardiography
Clinical InvestigationApplication of Ultrasound-Enhancing AgentsRoutine Use of Contrast on Admission Transthoracic Echocardiography for Heart Failure Reduces the Rate of Repeat Echocardiography during Index Admission
Graphical abstract
Section snippets
Study Population
Between January 2014 and December 2017, there were 9,115 admissions to Piedmont Atlanta Hospital (5,067 men; mean age, 68.4 ± 15.0 years; average LV ejection fraction [LVEF], 43 ± 17%) for HF or HF-related symptoms that were associated with at least one TTE examination during the admission (eligible HF admissions for this study). Admissions were identified from the Piedmont electronic medical record system on the basis of HF symptoms (e.g., dyspnea, shortness of breath, chest pain) and
HF Admission Demographics and UEA Echocardiography
Eligible HF admissions to Piedmont Atlanta Hospital increased from 1,867 in 2014 to 2,655 in 2017, totaling 9,115 admissions over the 4-year period (Table 1). Of these, 5,600 patients received UEAs in the first TTE examination (contrast group) and 3,515 patients did not receive UEAs in the first TTE examination (noncontrast group). The noncontrast group consisted of patients not receiving contrast because of known contraindications or hypersensitivity to microbubble contrast (n = 26 [0.7%]),
Discussion
Data from this observational study demonstrate that among patients who were admitted with suspected or confirmed HF, both suboptimal image quality and lack of UEA use in the first TTE examination was associated with an increased likelihood of repeat echocardiographic testing. Whereas poor image quality is a previously validated, clinically understood justification for repeat testing, the potential merits of UEA use regardless of image quality have not previously been elucidated. Our data
Conclusion
The use of UEA in the first TTE examination at HF admission irrespective of image quality was associated with a nearly fivefold decrease in unjustified repeat TTE imaging during an index hospitalization. In comparison, optimal baseline image quality was also correlated with only a twofold decrease in the likelihood of repeat TTE testing. The use of UEA in the first TTE study for HF admission regardless of image quality was also associated with significant reduction in LOS and 20% reduced odds
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Cited by (0)
Dr. Vannan is a speakers bureau member and has received research grants and speaking honoraria (all payments and grant support to Piedmont Heart Institute). Dr. Green has received consulting payments.