The role of transthoracic echocardiography in the management of patients seen in an outpatient cardiology clinic.

Transthoracic two-dimensional (2D) Doppler echocardiography may provide new or additional information in patients, but it is often not known whether the results alter the treatment plan. We investigated whether results of clinically indicated 2D echocardiography were different from the physician's clinical examination or led to changes in management in 200 consecutive outpatients seen in a university-based clinic. A questionnaire was completed by the physician regarding physical findings and treatment plan before 2D echocardiography was performed. After results were known, the physician was asked to report any differences compared with clinical examination or changes in patient management. Most patients (83%) were studied to evaluate left ventricular (LV) or valvular function. 2D echocardiography confirmed clinical assessment in 182 patients (one inadequate 2D echocardiogram) and disclosed a new diagnosis in 17. 2D echocardiography provided additional information, not expected from clinical assessment or history, in 94 patients. Clinical assessment, compared with 2D echocardiography, was concordant in 154 (77%) of 199 patients with regard to LV systolic function but in only 22 (50%) of 44 with valve disease. Alterations in management based on results of 2D echocardiography were instituted in 73 patients (36%), most often manifested by changes in pharmacologic therapy (n = 45; 62%). Results of 2D echocardiography obviated the need for further cardiac evaluation, surgery, or procedures in 30 patients, avoiding additional patient charges of $125,754.00. In contrast, results of 2D echocardiography led to the need for further evaluation, surgery, or procedures in 32 patients, resulting in additional patient charges of $70,860.00. In conclusion, 2D echocardiography provides new or additional information that results in changes in management strategy in one third of patients, and 2D echocardiography offers relative cost savings by avoiding additional procedures.