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Clinical utility of echocardiographic exams can be broadened, studies say.

SAN DIEGO -- The traditional echocardiographic examination has been limited to the heart, but by taking several extra minutes to point the transducer in other directions, echocardiography becomes transformed into a valuable cardio-vascular screening tool, Dr. Bruce Kimura said at the annual meeting of the American Society of Echocardiography.

In a proof-of-principle study involving 109 patients referred for an echocardiography exam, the application of a protocol involving additional ultrasound screening for abdominal aortic aneurysm, carotid atherosclerosis, and anomalous jugular veins added on average a mere 3.3 minutes to the duration of the standard echo exam while producing a positive diagnostic yield of 58% for one or more of the extracardiac abnormalities, said Dr. Kimura of Scripps Mercy Hospital, San Diego.

Good-quality ultrasound images were obtained in 77% of the neck exams but only 44% of the abdominal exams, primarily because bowel gas was a limiting factor in many cases.

On the basis of the results of the cardiovascular ultrasound screening exam, 1% of study participants were diagnosed as having abdominal aortic aneurysm, 16% had anomalous internal jugular veins, and 49% had significant carotid atherosclerosis. All three of these conditions are typically asymptomatic, the cardiologist noted.

Although a formal cost-benefit analysis wasn't done as part of this study, it seems likely that incorporating a cardiovascular-screening imaging protocol into the standard echocardiography examination provides a cost-effective opportunity to enhance the clinical value of an echocardiographic referral, Dr. Kimura added.

In a separate presentation, Dr. Sebastiaan C.A. Bekkers reported on 796 patients referred for echocardiography who underwent screening for abdominal aortic aneurysm during the echocardiographic exam.

The diagnostic yield from the abdominal aneurysm screening was so great that such screening ought to be routinely included as part of the standard transthoracic echo exam, at least in patients over the age of 55, argued Dr. Bekkers of University Hospital Maastricht, the Netherlands.

The abdominal aorta could be visualized in 93.2% of the patients. Abdominal aortic aneurysm was identified in 5.7% of those patients, including 4.6% of them who were not previously known to have the condition.

More than two-thirds of echocardiographically detected abdominal aortic aneurysms were 30-40 mm in diameter. Four of the 34 patients with a previously unknown abdominal aortic aneurysm had a lesion diameter in excess of 50 mm; two of those patients underwent urgent surgery.

No patient younger than 55 years was found to have an abdominal aortic aneurysm.

After age 70 years, the prevalence of the disorder became significantly greater in men than women by a margin of 19.1% to 3.4%, Dr. Bekkers said.

BY BRUCE JANCIN

Denver Bureau
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Title Annotation:Cardiovascular Medicine
Author:Jancin, Bruce
Publication:Internal Medicine News
Geographic Code:1USA
Date:Oct 15, 2004
Words:435
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