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Echocardiography effectively assesses known heart conditions, confirming diagnoses in 70% of cases. However, its utility is limited for ruling out unsuspected cardiac diseases, with a low diagnostic yield in such referrals.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Echocardiography is a key diagnostic tool in cardiology.
- Understanding its utility in various referral scenarios is crucial for optimizing its use.
Purpose of the Study:
- To analyze echocardiographic study requests to identify common cardiac abnormalities.
- To evaluate the diagnostic yield and usefulness of echocardiography based on referral patterns.
Main Methods:
- Retrospective analysis of 1557 consecutive echocardiographic studies.
- Categorization of identified cardiac abnormalities (valvular, congenital, cardiomyopathies, pericardial).
- Assessment of diagnostic yield based on clinical suspicion versus "rule out" referrals.
Main Results:
- Organic heart disease was identified in 1240 patients (79.6%).
- Acquired valvular heart disease was the most common abnormality (43.6%).
- Diagnostic yield was high (96.8%) for suspected heart disease, confirming diagnoses in 70% and altering them in 26.9%.
- Yield was low (34.2%) for "rule out" referrals, representing only 12% of total positive findings.
Conclusions:
- Echocardiography is highly valuable for assessing known or suspected cardiac abnormalities.
- Its effectiveness is significantly lower in detecting unsuspected heart disease when used for "rule out" purposes.
- Echocardiography is a dependable, cost-effective tool for evaluating established cardiac conditions.
Abstract:
Consecutive requests of 1557 echocardiographic studies performed between January 1984 and June 1988 were analysed in order to identify common cardiac abnormalities encountered, the pattern of referral and most important the usefulness of the procedure at our hospital. Organic heart disease was found in 1240 patients, of whom 541 (43.6%) had acquired valvular heart disease; 338 (27.4%) congenital heart abnormalities; 154 (12.4%) cardiomyopathies; 139 (11.2%) pericardial disease and 68 (5.4%) other cardiac abnormalities. The diagnostic yield was high 1093/1128 (96.8%) when heart disease was clinically diagnosed or strongly suspected. It confirmed stated diagnosis in 789 (70.0%) and the echocardiographic diagnosis was different from that of the referral in 304 (26.9%). In the remaining 35 (3.1%) no heart disease could be identified. The yield was low, 147/429 (34.2%) (12% of the total positives), when patients were referred to "rule out" or "exclude" heart disease. It is concluded that echocardiography is not very useful for the detection of unsuspected diseases, while on the other hand, it is a simple, relatively cheap and highly dependable tool in the assessment of known cardiac abnormalities.