Is Quantitation a Good Value?
Paul Heidenreich, MD, MS
Stanford University, VA Palo Alto Health Care System, Section of Cardiology (111C), 3801 Miranda Avenue, Palo Alto, California 94304
Detaint et al. (1) show that averaging up to 3 quantitative measures of aortic regurgitation (AR) provides prognostic value. They note that the association with mortality was significant for quantitative measures (p = 0.05), but not for qualitative measures (p = 0.15). Although the difference in mortality prediction seems small, and could have been tested directly, it makes sense that quantitative measures are more accurate than qualitative ones. Dr. Carabello (2) bemoans the limited use of quantitation by the community and ponders why this might be. I suggest that clinicians and laboratory managers may question the value of quantitation.
Although the elegant study by Detaint et al. (1) gives us evidence that quantitation has incremental benefit over qualitative reporting, the incremental cost to get this incremental benefit is not described. Where does one reach flat-of-the-curve value with quantitation? Would it not be even more accurate to average the measures of aortic regurgitation on each of 10 beats per patient taken on 3 different days? Detaint et al. (1) could not be expected to address the cost effectiveness of AR quantitation in the space allowed. However, their next step (and that of all who wish to promote any diagnostic strategy) should be to test or model how the improvement in accuracy with a new diagnostic strategy can improve patient outcome, and that any associated increase in cost is worth it to patients and society.
(Email: heiden{at}stanford.edu).
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REFERENCES
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- Detaint D, Messika-Zeitoun D, Maalouf J, et al. Quantitative echocardiographic determinants of clinical outcome in asymptomatic patients with aortic regurgitation J Am Coll Cardiol Img 2008;1:1-11.[Abstract/Free Full Text]
- Carabello BA. Cardiologists: do we have the right to call ourselves physiologists? J Am Coll Cardiol Img 2008;1:12-14.[Free Full Text]
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