title: Effect of performing real time three-dimensional transesophageal echocardiography in addition to two-dimensional transesophageal echocardiography on operator diagnostic confidence.
abstract: BACKGROUND
  This study evaluates the effects of performing real time three-dimensional transesophageal echocardiography in addition to conventional two-dimensional transesophageal echocardiography on diagnostic confidence.
  
  
  METHODS
  Operator diagnostic confidence in addressing clinical questions posed by the referral was scored using a five-point scale for two-dimensional transesophageal echocardiography alone and the combination of two-dimensional and real time three-dimensional transesophageal echocardiography in 136 consecutive patients undergoing examination in an academic hospital.
  
  
  RESULTS
  Mean diagnostic confidence score was higher for the combined studies compared to two-dimensional transesophageal echocardiography alone (4.5 vs. 4.1, P < 0.001)). The addition of real time three-dimensional transesophageal echocardiography increased diagnostic confidence score in 45 (33.1%) patients, and the percentage of studies with total diagnostic confidence rose from 40.4% with two-dimensional transesophageal echocardiography alone to 65.4% after performing real time three-dimensional transesophageal echocardiography. Type of clinical indication was associated with improved score by the combined exams (P < 0.004). The addition of real time three-dimensional transesophageal echocardiography was most likely to improve diagnostic confidence score in studies performed to assess valve disease (56.1%) and least likely in examinations performed for intracardiac infection (14.9%). The location (anterior or posterior) of the primary cardiac pathology was not associated with improved score by the combined studies (P = 0.498).
  
  
  CONCLUSIONS
  The addition of real time three-dimensional transesophageal echocardiography to two-dimensional transesophageal echocardiography increases diagnostic confidence in examinations routinely performed in an academic practice. Further studies of the impact of real time three-dimensional transesophageal echocardiography on patient management, outcomes and displacement of or need for downstream testing are warranted.
authors.affiliation: Department of Medicine, Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida Cardiology Section, Bruce W. Carter VAMC, Medical Service, Miami, Florida Philips Healthcare, Andover, Massachusetts.
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Willens
authors.forename: Robert C
authors.initials: RC
authors.lastname: Hendel
authors.forename: Jian Xin
authors.initials: JX
authors.lastname: Qin
authors.forename: Carol
authors.initials: C
authors.lastname: Ma
authors.forename: Karen
authors.initials: K
authors.lastname: Keith
authors.forename: Silvia
authors.initials: S
authors.lastname: Torres
authors.forename: Jay R
authors.initials: JR
authors.lastname: Grossman
authors.forename: Mauro
authors.initials: M
authors.lastname: Moscucci
mesh_terms: D000368:Aged; D003199:Computer Systems; D015150:Echocardiography, Doppler / Q000379:methods*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity