Several associations have partnered to release new appropriateness criteria for two common cardiac ultrasound techniques – transthoracic (TTE) and transesophageal (TEE) echocardiography. The criteria were unveiled at the 18th Annual Scientific Sessions of ASE in Seattle this week. The effort has been undertaken to ensure quality cardiac ultrasound imaging for all patients and to avoid unnecessary use of the technology
The criteria were developed jointly by the American College of Cardiology Foundation (ACCF) and the American Society of Echocardiography (ASE) in partnership with the 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.
The TTE/TEE Appropriateness Criteria review common scenarios found in clinical practice and address the appropriateness of ordering echocardiograms for each situation. The criteria address a broad range of clinical situations in which TTE/TEE might be used, such as for patients presenting with signs and symptoms that could represent heart disease, like murmurs and palpitations, and conditions such as hypertension, stroke, heart valve disease, and suspected or known congenital heart disease.
“For the very first time, we are formally addressing the appropriate use of one of the earliest and most commonly used imaging technologies,” said Pamela S. Douglas, MD, MACC, FASE, who is the chair of the TTE/TEE Appropriateness Criteria Writing Group, and past president of both the ACC and ASE. “Although the concept of proper use of technology is not new, providing physicians with the tools to assess our own practice patterns is a critically important and new undertaking. It gives real meaning to our efforts to promote quality in cardiovascular care.”
The organizations believe that though both TTE and TEE are relatively easy on the patient and low risk, and are provide very comprehensive information, the possibility exists that there could be inappropriate use in patients who may not benefit from having the exam. In fact, 14 scenarios addressed in the criteria were found to be inappropriate reasons for performance of the TTE/TEE study.
Therefore, the criteria for TTE/TEE should help guide physicians in determining when and how often to use the tests. In general, use of TTE/TEE for the initial evaluation of structure and function was viewed favorably, while routine repeat testing and general screening uses in certain clinical scenarios were viewed less favorably.
The criteria can be found here www.asecho.org