title: Clinical utility of transthoracic two-dimensional and Doppler echocardiography.
abstract: OBJECTIVE
  The purpose of this study was to determine the value of contemporary echocardiography for patient diagnosis and management in clinical practice.
  
  
  BACKGROUND
  Although the use of echocardiography is growing rapidly, there is little information about its clinical utility.
  
  
  METHODS
  A prospective observational study was performed at a community-based, tertiary care teaching hospital. Physicians were interviewed before and after learning the result of their patients' echocardiographic examination. Chart reviews were performed to confirm reports of new diagnoses and treatments that resulted from echocardiography.
  
  
  RESULTS
  Physician interviews were successfully completed for 244 (49%) of 497 inpatients and 101 (30%) of 336 outpatients. Among patients with moderate or greater mitral regurgitation, the diagnosis of "clinically significant" mitral regurgitation was unsuspected in 5 (31%) of 16 outpatients and 28 (60%) of 47 inpatients. Among the patients with left ventricular wall motion abnormalities, the result was unsuspected in 7 (50%) of 14 outpatients and 18 (22%) of 81 inpatients. As assessed by chart review, echocardiography produced a definite new diagnosis in 25 inpatients (10%) and 5 outpatients (5%) and was responsible for changes in pharmacologic treatment in at least 16 inpatients (7%) and 2 outpatients (2%).
  
  
  CONCLUSIONS
  The echocardiogram commonly provided information that was unexpected. This information provided a definite new diagnosis or treatment in a smaller proportion of the patients. Further research is necessary to define the appropriate yield that would warrant echocardiography on the basis of both clinical and cost-effectiveness criteria.
authors.affiliation: Department of Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: H M
authors.initials: HM
authors.lastname: Krumholz
authors.forename: P S
authors.initials: PS
authors.lastname: Douglas
authors.forename: L
authors.initials: L
authors.lastname: Goldman
authors.forename: C
authors.initials: C
authors.lastname: Waksmonski
mesh_terms: D000328:Adult; D000368:Aged; D001900:Boston / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology; D016009:Chi-Square Distribution; D004452:Echocardiography / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D015150:Echocardiography, Doppler / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000706:statistics & numerical data; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data