Impact of repeat echocardiograms on management decisions in patients rehospitalized with acute decompensated heart failure.
Aurora L, Gorgis S, Gandolfo C, Sadiq O, Mahan M, and Ananthasubramaniam K. Impact of repeat echocardiograms on management decisions in patients rehospitalized with acute decompensated heart failure. J Am Soc Echocardiogr 2018; 31(6):B89-B90.
J Am Soc Echocardiogr
Background: Transthoracic echocardiography (TTE) at the time of acute decompensated heart failure (ADHF) may reveal significant structural and hemodynamic abnormalities that can classify risk, guide clinical management, and aid resource utilization. TTE is considered appropriate for enhancing diagnosis and guiding downstream management. However, the clinical impact of routine repeat TTE in uncomplicated ADHF re-admissions is yet to be established. We studied patients with repeat TTE at the time of re-hospitalization for ADHF to determine the clinical impact of TTE. Methods: In a single center retrospective study, 413 adult patients with 2 ADHF admissions within 1 year period were studied. Those with clear indications for repeat TTE (myocardial infarction, stroke, arrhythmias, hemodynamic instability, or valve disease) were excluded. 198 patients met inclusion criteria. Two groups were defined: those with significant interventions (SI: heart catheterizations, other cardiac procedures, nuclear scans, or specialty consultations) and minimal interventions (MI: medication or no changes). Demographic data, echocardiography parameters, procedures, and medications changes were evaluated. Results: Out of 198 patients, 85 patients comprised the SI group and 113 patients were in the MI group. Non-ischemic cardiomyopathy was the predominant etiology of heart failure observed in both groups (p=0.251). BNP on second presentation of ADHF was statistically worse than the prior admission (p=0.014). As a result of repeat TTE, no significant changes in left ventricular ejection fraction were observed in both groups MI and SI (p=0.131 and p=0.236, respectively). Within the valve disease subgroup, those with underlying mitral regurgitation who underwent MI had significant improvement of their valvular disease (p=0.005). This effect was not noted in patients who had advanced interventions (p=0.141). Despite SI, those patients with diastolic dysfunction trended to worsen despite repeat TTE (p=0.074). Conclusion: Many patients undergo repeat TTE routinely in the setting of ADHF. In our results, the predominant impact of repeat TTE in re-hospitalized ADHF involved minimal interventions such as medication changes, rather than significant interventions including procedures or specialty consultations. Echocardiography continues to serve an important role in patient management decisions, but clinicians should focus on reserving utilization of repeat TTE in uncomplicated ADHF readmissions to those not responding to standard medical optimization and diuresis.