Prevalence of non-cardiac pathology on clinical transthoracic echocardiography

Abstract

Background: Non-cardiac findings (NCFs) are seen in more than a third of cardiac computed tomographic and cardiac magnetic resonance imaging studies. The prevalence and importance of NCFs in transthoracic echocardiographic (TTE) imaging is unknown. The aim of this study was to determine the prevalence of NCFs on TTE imaging.

Methods: The subcostal images of all comprehensive adult TTE studies performed at one institution in December 2008 were retrospectively reviewed for NCFs by a radiologist with fellowship training in cardiovascular and abdominal radiology and blinded to the TTE report findings and clinical histories. Additional TTE image orientations were assessed in a subset of 300 studies. NCFs were categorized as benign (e.g., simple hepatic cyst), indeterminate (e.g., ascites), or worrisome (e.g., liver metastases). If an indeterminate or worrisome NCF was identified, the patient's electronic medical record was reviewed to determine if the NCF was previously known.

Results: Of 1,008 TTE studies (443 inpatient, 565 outpatient) in 922 patients, 77 NCFs were identified in 69 patients (7.5%). These included 20 benign (26%), 52 indeterminate (67%), and five worrisome (7%) NCFs. Intermediate and worrisome NCFs were more common in inpatient TTE studies (9% vs 3% outpatient, P = .002). The additional views demonstrated 2% more NCFs. Record review demonstrated that 60% of worrisome and 67% of indeterminate NCFs were previously known. No unknown NCF ultimately led to a change in patient management.

Conclusions: Clinical TTE studies demonstrate NCFs in 7.5% of all patients, with an increased prevalence on inpatient studies. Although 75% of NCFs were potentially management changing, the majority of these were previously known and very unlikely to lead to management changes. Further study is needed to validate these findings in other populations and to assess their clinical impact.