Background

Normal electrocardiographic (ECG) results have been reported to be associated with a low prevalence of structural heart disease and thus may preclude the need for transthoracic echocardiographic (TTE) imaging. The goal of this study was to determine the prevalence of important TTE abnormalities in patients with a normal ECG referred for TTE imaging.

Methods

Consecutive electrocardiograms over 6 months were reviewed. Patients with a normal ECG who underwent TTE imaging within 30 days formed the study group. TTE indication and appropriateness designation were determined. TTE findings were noted, including a composite, “major TTE abnormalities” (Maj TTE ABNs).

Results

Of 26,254 electrocardiograms reviewed, 3,955 (15%) were normal, 522 with qualifying TTE studies. Maj TTE ABNs were common (27%). The most common TTE indication was signs or symptoms of congestive heart failure (17%), 35% of which had Maj TTE ABNs. Two echocardiographic indications were found to have significantly fewer of Maj TTE ABNs: palpitations (4%, P < .01) and preoperative evaluation before noncardiac surgery (6%, P < .01). A majority of TTE studies were appropriate (76%), with only 14% rarely appropriate. Maj TTE ABNs were less common in rarely appropriate compared with appropriate TTE studies (13% vs 30%, P < .01), with a very low prevalence of Maj TTE ABNs in outpatient rarely appropriate TTE studies (4%).

Conclusions

Clinically important TTE abnormalities in patients with a normal ECG are common, suggesting that normal ECG results should not routinely preclude TTE imaging to identify structural heart disease. However, recognition of common clinical indications and application of the appropriate use criteria may identify patients with a normal ECG in whom TTE imaging is of very low yield.

中文翻译：

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经胸腔超声心动图检查正常心电图的患者中，临床重要的超声心动图异常的高患病率

背景

据报道，正常的心电图（ECG）结果与结构性心脏病的低患病率相关，因此可能排除了经胸超声心动图（TTE）成像的需要。这项研究的目的是确定在进行TTE成像的正常ECG患者中重要TTE异常的患病率。

方法

复查连续6个月以上的心电图。心电图正常且在30天内接受TTE成像的患者组成研究组。确定了TTE适应症和适当性指定。记录了TTE的发现，包括复合的“主要TTE异常”（Maj TTE ABNs）。

结果

在所审查的26,254张心电图中，有3,955张（15％）是正常的，有522份经过TTE研究合格。TTE ABN少校很普遍（27％）。最常见的TTE指征是充血性心力衰竭的体征或症状（17％），其中35％患有Mae TTE ABN。发现两种超声心动图适应证的Maj TTE ABN明显减少：心（4％，P  <.01）和非心脏手术前的术前评估（6％，P  <.01）。大部分TTE研究是适当的（76％），只有14％很少是适当的。与适当的TTE研究相比，Maj TTE ABN在罕见的情况下较少见（13％vs 30％，P  <.01），而在门诊的很少进行TTE的研究中，Maj TTE ABN的患病率很低（4％）。

结论

心电图正常的患者在临床上重要的TTE异常很常见，这表明正常的心电图结果不应常规排除TTE成像以鉴别结构性心脏病。但是，对常见临床指征的识别和适当使用标准的应用可能会识别出具有正常ECG的患者，其中TTE成像的收率非常低。