Feature | March 07, 2013

Echocardiograms for Valvular Regurgitation May Be Overused

The American Society of Echocardiography joins with 16 other specialty groups—releasing a list of “Five Things Physicians and Patients Should Question” at a national event in Washington, D.C

An echocardiogram being performed on a patient using a Toshiba ultrasound system at ASE 2017. ASE offers appropriate use criteria (AUC) for echocardiograms.

March 7, 2013 — The American Society of Echocardiography (ASE) has released a list of five interventions whose appropriateness physicians and patients should discuss as part of Choosing Wisely, an initiative of the ABIM Foundation, along with Consumer Reports. First in the list, they ask that patients and their doctors talk about the real need for additional echocardiograms when there are only minor signs of heart valve leakage.

Do not order follow up or serial echocardiograms for surveillance after a finding of trace valvular regurgitation on an initial echocardiogram.

As access to healthcare information has become more readily available to concerned patients, a growing number of doctors have become involved in evaluating, ordering and caring for patients with a wider range of heart health problems rather than sending them directly to a specialist to follow these issues. Additionally, the technology associated with medical testing has improved and miniaturized, leading to increased utilization of echocardiography to quickly and painlessly evaluate the patient’s heart. With the increase in testing and improvements in technology, it is now common for physicians to find trace valve regurgitation, or leakage, that in the past no one would have been aware was present. This may lead to anxiety, misleading results and more questions for a patient who has a limited understanding of echo reporting.

Trace regurgitation is a very mild leak of a heart valve, which occurs when a valve does not close tightly, allowing blood to leak backward in your heart. Nearly all of the normal population will have a finding of some trivial or mild degree of regurgitation of one, two or three heart valves on a normal echocardiogram. This is sometimes called “physiologic” regurgitation by the doctor interpreting the echocardiogram. In most cases, a doctor, used to seeing these types of patients, will not even mention this finding to the patient as a way of avoiding the anxiety associated with this disclosure, which would be an essentially normal finding in most patients.

Trace, physiologic, and in most cases, mild regurgitation of the mitral, tricuspid or pulmonic valve reported on an echocardiogram requires no immediate or long term follow up. Following up on these findings with additional testing should only be done if you and your doctor believe you have signs and symptoms of the leakage progressing or getting worse. These signs may include a murmur (an abnormal sound when the doctor listens to your heart), fatigue, chest pain, shortness of breath, or extra, or funny, heart beats.

If a patient has trace regurgitation of the aortic valve, their doctor may choose to follow the regurgitation with future echocardiograms and additional physical examinations.

The goal of Choosing Wisely is to promote conversations between physicians and patients about utilizing the most appropriate tests and treatments and avoiding care that may provide no benefit.

ASE’s testing cardiovascular care scenarios were chosen based on the highest likelihood of improving patient care and reducing inappropriate test use. Leaders in the organization transformed the scenarios into plain language and produced the clinical explanations for each procedure. In particular, ASE’s cardiovascular care experts, reviewed the ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriateness Use Criteria for Echocardiography (AUC), which was published in March 2011. Here is a link to the most current version of the ASE AUC guidelines.

ASE encourages all medical professionals engaged in cardiovascular care to read the

“Five Things Physicians and Patients Should Question” lists at www.choosingwisely.org, and to engage their patients in conversations about reducing inappropriate tests and procedures with a goal of improving care and avoiding harm.

Consumer Reports, along with a coalition of consumer partner organizations, is also a part of the Choosing Wisely effort and is working with many of the societies to help patients understand the tests and treatments that are right for them.

For more information: www.asecho.org, www.choosingwisely.org

 

Related Content:

ASE Releases List of Five Tests or Procedures That May Be Overused

Top Echocardiography News and Video From ASE 2017

A Glimpse Into the Future of Cardiac Ultrasound

 

Related Content

New Oral Anticoagulant Drugs Associated with Lower Kidney Risks
News | Antiplatelet and Anticoagulation Therapies| December 12, 2017
Mayo Clinic researchers have shown a link between which type of oral anticoagulant a patient takes to prevent a stroke...
ECG Study of NBA Players Shows Need for Sport-Specific Normative Data and Guidelines
News | ECG| December 08, 2017
Cardiologists at NewYork-Presbyterian/Columbia University Irving Medical Center compared electrocardiographic findings...
Videos | Advanced Visualization| December 07, 2017
Dianna Bardo M.D., director of body MR and co-director of the 3-D Innovation Lab at Phoenix Children's Hospital.
New Study Suggests Protein Could Protect Against Coronary Artery Disease

Patients with no obstructed blood flow in the coronary arteries had higher levels of CXCL5 (blue) compared to patients with moderate levels (green) or lower levels (yellow) of CXCL5, who had increased severity of coronary obstructions (indicated by the arrows). Credit: Schisler lab

News | Cardiac Diagnostics| December 07, 2017
December 7, 2017 — The buildup of plaque in the heart’s arteries is an unfortunate part of aging.
New Tool Predicts Risk of Heart Attack in Older Surgery Patients
News | Cardiac Diagnostics| December 05, 2017
A tool designed to more accurately predict the risk of heart attack in older patients undergoing non-cardiac surgery...
Screening for Critical Congenital Heart Disease at Birth Saves Lives
News | Congenital Heart| December 05, 2017
Infant deaths from critical congenital heart disease (CCHD) decreased more than 33 percent in eight states that...
Toshiba Medical Rolls Out Interactive Learning Tools for Ultrasound and Vascular Training
News | Ultrasound Imaging| December 04, 2017
Toshiba Medical, a Canon Group company, introduced new educational tools and interactive learning resources to help...
Philips Azurion Platform Improves Clinical Workflow and Staff Experience Benefits
News | Angiography| December 04, 2017
Philips recently announced the results of a comprehensive, independent, two-year study demonstrating the clinical...
Samsung Unveils Mobile CT OmniTom at RSNA 2017
Technology | Computed Tomography (CT)| November 26, 2017
Samsung Electronics debuted its OmniTom mobile 16-slice computed tomography (CT) scanner at the Radiological Society of...
Coffee Associated With Reduced Risk of Heart Failure, Stroke. AHA 2017. #AHA2017
News | Heart Failure| November 25, 2017
November 25, 2017 — Drinking coffee may be associated with a decreased risk of developing heart failure or having str
Overlay Init