title: Appropriate use criteria for transesophageal echocardiography in Greece: A single center experience.
abstract: BACKGROUND
  The American College of Cardiology Foundation (ACCF) along with the American Society of Echocardiography (ASE) have enabled an accurate and clinically oriented evaluation of echocardiography indications by introducing Appropriate Use Criteria (AUC).
  
  
  OBJECTIVE
  This study was designed to evaluate the degree of implementation of AUC for transesophageal echocardiography (TEE) during daily clinical practice in a tertiary university hospital in Greece during the era of economic recession.
  
  
  METHODS
  From November 2014 to May 2014, we prospectively enrolled 300 patients who were examined in the Echocardiography Laboratory of the First University Cardiology. We recorded the participants' demographic and clinical characteristics using questionnaires and followed a scoring process according to ACCF guidelines to classify patients into an appropriate, inappropriate or uncertain category. The primary endpoint was to assess the association between the class of appropriateness and abnormal TEE results.
  
  
  RESULTS
  In 89.4% of patients labelled appropriate, TEE was abnormal and significantly higher compared to patients of uncertain eligibility (50%) and to patients for whom TEE was considered to be inappropriate (35%) (p < 0.001). Subgroup analysis revealed a positive association between AUC and an increased possibility for abnormal TEE in female subjects (p = 0.001) as well as in patients who were younger than 50 years old (p < 0.001). A significant association was finally established between AUC and abnormal findings in TEE in patients with no risk factors (p = 0.028) and in patients with more than 3 risk factors (p = 0.013).
  
  
  CONCLUSIONS
  TEE constitutes a medical practice with an optimal cost/effectiveness ratio and should be further encouraged in our country in accordance with the austerity policy as long as the AUC are generally applied.
authors.affiliation: 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece. Electronic address: georgiopoulosgeorgios@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Georgiopoulos
authors.affiliation: 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: C
authors.initials: C
authors.lastname: Aggeli
authors.affiliation: 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Laina
authors.affiliation: 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Deligianni
authors.affiliation: 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Oikonomou
authors.affiliation: 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Lampridou
authors.affiliation: 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Vogiatzi
authors.affiliation: 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Tousoulis
mesh_terms: D000328:Adult; D000368:Aged; D002309:Cardiology / Q000458:organization & administration* / Q000592:standards; D015897:Comorbidity / Q000639:trends; D017548:Echocardiography, Transesophageal / Q000592:standards* / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006115:Greece / Q000453:epidemiology; D019983:Guideline Adherence; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors
keywords: Appropriate use criteria; Appropriateness; Transesophageal echocardiography