Comparison of echocardiographic diagnoses between the echocardiography laboratory of the university hospital and the district hospital Original article
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Abstract
Introduction: Echocardiography in district general hospitals (DGH) in some European countries is still much less available than in multidisciplinary tertiary care hospitals (TCH). Team from a TCH started a cardiology consultantlead echo service in a rural DGH.
Purpose of the study: The purpose of this report was to compare the results of the echocardiographic studies performed in the same period of time, by the same cardiologist in a university general cardiology department and a DGH general medicine ward.
Methods: Echocardiographic studies in both settings were performed using standard ultrasound units. 100 consecutive routine results of studies performed in DGH and in TCH were analyzed retrospectively.
Results: In DGH there was significantly more patients referred with heart failure (24 vs. 9; p < 0.001) and hypertension (44 vs. 13; p < 0.001). DGH patients had significantly larger left ventricular (LV) diameter (50,1 ± 8,3 mm vs. 46,7 patients (48,8% ± 12% vs. 52,7% ± 9,0%; p < 0.05). In DGH subjects there were more regional wall motion abnormalities compared to subjects from TCH (48 vs. 23; p < 0.02). Aortic stenosis prevalence was similar in both settings (17 vs 12; NS). However, there were more cases of moderate and severe aortic stenosis in DGH (8 vs. 1; p < 0.05). There were no differences in number of patients with tricuspid regurgitation, pulmonary regurgitation and pericardial effusion.
Conclusions: Our analysis showed that in a DGH there were severe echocardiographic abnormalities detected after introduction of a consultant-lead on-site echocardiographic service. We can draw a conclusion, that in a district general hospital setting there is a great need for availability of echocardiographic service and cardiac consultants to provide optimal patient care.
± 6,8 mm; p < 0.01) and left atrium (42,1 ± 6,7 mm vs. 40,7 ± 6,0 mm; p < 0.05). Ejection fraction was lower in DGH
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References
2. Lipiec P., Plonska-Gosciniak E., Kusmierek J. et al.: Safety of non-invasive cardiovascular imaging techniques. Expert consensus statement of the polish clinical forum for cardiovascular imaging. Kardiol. Pol. 2013; 71: 301-307.
3. Douglas P.S. Improving imaging: Our professional imperative. J. Am. Coll. Cardiol. 2006; 48: 2152-2155.
4. Willens H.J., Gomez-Marin O., Heldman A. et al.: Adherence to appropriateness criteria for transthoracic echocardiography: Comparisons between a regional department of veterans affairs health care system and academic practice and between physicians and mid-level providers. J. Am. Soc. Echocardiogr. 2009; 22: 793-799.
5. Kirkpatrick J.N., Ky B., Rahmouni H.W. et al.: Application of appropriateness criteria in outpatient transthoracic echocardiography. J. Am. Soc. Echocardiogr. 2009; 22: 53-59.
6. Ward R.P., Krauss D., Mansour I.N. et al.: Comparison of the clinical application of the American College of Cardiology foundation/American Society of Echocardiography appropriateness criteria for outpatient transthoracic echocardiography in academic and community practice settings. J. Am. Soc. Echocardiogr. 2009; 22: 1375-1381.
7. Blecker S., Bhatia R.S., You J.J. et al.: Temporal trends in the utilization of echocardiography in Ontario, 2001 to 2009. JACC Cardiovasc. Imaging 2013; 6: 515-522.
8. Pearlman A.S., Ryan T., Picard M.H. et al.: Evolving trends in the use of echocardiography: A study of medicare beneficiaries. J. Am. Coll. Cardiol. 2007; 49: 2283-2291.
9. Drozdz J., Krzeminska-Pakula M., Krecki R. et al.: Prognostic value of the parameters of left ventricular systolic function in patients with heart failure. Przegl. Lek. 2004; 61: 664-668.
10. Bruch C., Rothenburger M., Gotzmann M. et al.: Risk stratification in chronic heart failure: Independent and incremental prognostic value of echocardiography and brain natriuretic peptide and its n-terminal fragment. J. Am. Soc. Echocardiogr. 2006; 19: 522-528.
11. McMurray J.J., Adamopoulos S., Anker S.D. et al.: ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the heart failure association (HFA) of the ESC. Eur. Heart J. 2012; 33: 1787-1847.
12. Bello V.D., Carrubba S.L., Antonini-Canterin F. et al.: Role of electrocardiography and echocardiography in prevention and predicting outcome of subjects at increased risk of heart failure. Eur. J. Prev. Cardiol. 2013 Oct 8 [online].
13. Hamm C.W., Bassand J.P., Agewall S. et al.: ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The task force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur. Heart J. 2011; 32: 2999-3054.
14. Steg P.G., James S.K., Atar D. et al.: ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur. Heart J. 2012; 33: 2569-2619.
15. Drozdz J., Krzeminzska-Pakula M., Chrzanowski L. et al.: Predictors of long term outcome in medically treated patients with unstable angina. Can. J. Cardiol. 2003; 19: 135-139.
16. Plewka M., Drozdz J., Krzeminska-Pakula M. et al.: Prognostic value of colour doppler echocardiography in patients after myocardial infarction – 2-year follow-up. Acta Cardiol. 2002; 57: 66-67
17. Mancia G., Fagard R., Narkiewicz K. et al.: 2013 ESH/ESC guidelines for the management of arterial hypertension: The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur. Heart J. 2013; 34: 2159-2219.
18. Cuspidi C., Lonati L., Macca G. et al.: Cardiovascular risk stratification in hypertensive patients: Impact of echocardiography and carotid ultrasonography. J. Hypertens. 2001; 19: 375-380.
19. Cuspidi C., Meani S., Valerio C. et al.: Left ventricular hypertrophy and cardiovascular risk stratification: Impact and cost-effectiveness of echocardiography in recently diagnosed essential hypertensives. J. Hypertens. 2006; 24: 1671-1677.
20. Berko B.A., Owen A.N., Zwas D.R.: Echocardiography. The role of this noninvasive test in the geriatric population. Geriatrics 2003; 58: 30-34 (quiz 35).
21. Taylor J.: ESC/EACTS guidelines on the management of valvular heart disease. Eur. Heart J. 2012; 33: 2371-2372.
22. Iung B., Baron G., Butchart E.G. et al.: A prospective survey of patients with valvular heart disease in Europe: The euro heart survey on valvular heart disease. Eur. Heart J. 2003; 24: 1231-1243.
23. Nkomo V.T., Gardin J.M., Skelton T.N. et al.: Burden of valvular heart diseases: A population-based study. Lancet 2006; 368: 1005-1011.
24. Cecconi M., Chirillo F., Costantini C. et al.: The role of transthoracic echocardiography in the diagnosis and management of acute type a aortic syndrome. Am. Heart J. 2012; 163: 112-118.
25. Douglas P.S., Khandheria B., Stainback R.F. et al.: ACCF/ASE/ACEP/ASNC/SCAI/ SCCT/SCMR 2007 appropriateness criteria for transthoracic and transesophageal echocardiography: A report of the American College of Cardiology foundation quality strategic directions committee appropriateness criteria working group, American Society of Echocardiography, American College of Emergency Physicians, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society for Cardiovascular Magnetic Resonance endorsed by the American College of Chest Physicians and the Society of Critical Care Medicine. J. Am. Coll. Cardiol. 2007; 50: 187-204.
26. Douglas P.S., Garcia M.J., Haines D.E. et al.: ACCF/ASE/AHA/ASNC/ HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography. A report of the American College of Cardiology foundation appropriate use criteria task force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Endorsed by the American College of Chest Physicians. J. Am. Coll. Cardiol. 2011; 57: 1126-1166.
27. Gurzun M.M., Ionescu A.: Appropriateness of use criteria for transthoracic echocardiography: Are they relevant outside the USA? Eur. Heart J. Cardiovasc. Imaging 2014; 15(4): 450-455.
28. Marwick T.H., Neubauer S., Petersen S.E.: Use of cardiac magnetic resonance and echocardiography in population-based studies: Why, where, and when? Circ. Cardiovasc. Imaging 2013; 6: 590-596.
29. Gottdiener J.S., Bednarz J., Devereux R. et al.: American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J. Am. Soc. Echocardiogr. 2004; 17: 1086-1119.
30. Rao G., Sajnani N., Kusnetzky L.L. et al.: Appropriate use of transthoracic echocardiography. Am. J. Cardiol. 2010; 105: 1640-1642.
31. Ciesielczyk M., Drozdz J., Krzeminska-Pakula M. et al.: Clinical application of 3-dimensional echocardiography--a 3-year single center experience. Przegl. Lek. 2002; 59: 658-662.
32. Lipczynska M., Szymanski P., Klisiewicz A. et al.: Hand-carried echocardiography in heart failure and heart failure risk population: A community based prospective study. J. Am. Soc. Echocardiogr. 2011; 24: 125-131.
33. Michalski B., Kasprzak J.D., Szymczyk E. et al.: Diagnostic utility and clinical usefulness of the pocket echocardiographic device. Echocardiography 2012; 29: 1-6.