Echocardiography Testing Recommendations for Asymptomatic Patients

2012-11-05
 

 Medical Imaging Testing

Although exercise echocardiography testing could identify high-risk patients, researchers advised caution when recommending revascularization (RSV) because it does not indicate improved patient outcomes. This is especially problematic for asymptomatic patients, according to Serge C. Harb, M.D., of the department of cardiovascular medicine at the Cleveland Clinic Heart and Vascular Institute, and colleagues because early testing is of indeterminate value.

“Early testing” is defined as testing conducted less than two years after angioplasty, or percutaneous coronary intervention (PCI), and five years after coronary artery bypass graft (CABG) surgery.

They recommended that physicians deliberate before screening asymptomatic patients. “From a health economic standpoint, appropriateness of such testing must be carefully reviewed,” they wrote.

According to HealthImaging, the researcher’s goal was to examine the effectiveness of early and late testing of asymptomatic patients after RSV and treatment responses to determine whether treatment made a difference in outcomes. (Source: HealthImaging)

Benefit Lacking for Post-PCI & Post-CABG Patients

Both the American College of Cardiology (ACC) and American Heart Association (AHA) recommend the use of exercise echocardiography among possible stress imaging tests, but this is only to evaluate symptomatic patients after PCI or CABG surgery.

“The inappropriate use of noninvasive testing is not only costly but also could lead to unnecessary downstream testing and interventions such as coronary angiography and revascularization,” Dr. Harb, et. al., wrote, referring to asymptomatic patients.

In addition, Dr. Harb and colleagues noted that patients and physicians often chose to not act even when testing detected that the heart muscle wasn’t getting enough oxygen (also known as ischemia). This could be because, in many cases, ischemia is a temporary problem. The heart may be able to get enough blood through its diseased coronary arteries while at rest but may suffer from ischemia during exertion or stress, presenting, in effect, a “false positive.”

“Among patients with evidence of ischemia, 66 percent did not undergo revascularization (RVS), and of those who underwent RVS, 75 percent did not have ischemia on their exercise echocardiography. The decision to proceed with RVS was based more on the change in the clinical status of the patient with development of ischemic symptoms than on the sole result of the test,” they wrote.

They concluded that, while using a combination of test data may be effective in identifying at-risk patients, the incremental value of exercise echocardiography tests for asymptomatic patients was limited at best.

What are your thoughts on echocardiography testing for asymptomatic patients? I encourage you to share your thoughts via a comment below.

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