Current appropriate use criteria (AUC) for transthoracic echocardiography (TTE) may not adequately address the complexity of clinical cases encountered in the cardiac intensive care unit (CICU), according to a retrospective study published in Echocardiography.

There has been a significant increase in the use of echocardiography over the past 3 decades. Although this provides physicians with a large amount of clinical information in a rapid, portable, iterative, and safe manner, there has also been a concomitant rise in healthcare costs over this time period.

Therefore, several cardiovascular societies led by the American College of Cardiology Foundation and the American Society of Echocardiography have established AUC to promote cost-effective use of echocardiography; however, no study to date has evaluated the applicability of current AUC to TTEs performed in a CICU.

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Thus, researchers analyzed 2 years of consecutive TTEs performed in a CICU and found that of 826 TTEs, 619 were classified as appropriate, 12 as uncertain, 21 as rarely appropriate, and 174 could not be classified.

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The most common unclassifiable indication was, “initial evaluation of cardiac structure or function after cardiac arrest of unknown etiology” (n=101).

“In our study of 826 consecutive TTEs, 21.1% were unable to be classified according to 2011 [American College of Cardiology Foundation / American Society of Echocardiography] AUC, reflecting the difficulty in applying AUC to this unique clinical environment in that repeat testing may be useful in management of critically ill patients, that echocardiography may be a proper diagnostic test in certain situations, and that the CICU features certain devices (mechanical circulatory supports) that may require periodic echocardiographic surveillance.”

Thus, further studies are needed to better define the appropriateness of TTEs performed in the CICU.


Salik JR, Sen S, Picard MH, Weiner RB, Dudzinski DM. The application of appropriate use criteria for transthoracic echocardiography in a cardiac intensive care unit. Echocardiography. 2019;36:631-638.

This article originally appeared on The Cardiology Advisor