Table 4

Ordering Physician Specialty and TTE Findings for Inappropriate Indications (n = 157) in the AC for Echocardiography

Inappropriate Indication NumberAll Inappropriate Studies (n = 157)Percent Ordered by Cardiac SpecialistsPercent With New TTE AbnormalitiesPercent With New Major TTE Abnormalities
Number 5: Patients who have isolated APC or PVC without other evidence of heart disease, %11 (n = 17)29 (n = 5)12 (n = 2)6 (n = 1)
Number 7: Evaluation of LV function with previous ventricular function evaluation within the past year with normal function (such as previous echocardiogram, LV gram, SPECT, CMR) in patients in whom there has been no change in clinical status, %8 (n = 12)25 (n = 3)17 (n = 2)8 (n = 1)
Number 15: Initial evaluation of patient with suspected pulmonary embolism to establish diagnosis, %4 (n = 6)0 (n = 0)83 (n = 5)17 (n = 1)
Number 19: Routine (yearly) re-evaluation of mitral valve prolapse in patients with no or mild MR and no change in clinical status, %6 (n = 9)33 (n = 3)11 (n = 1)11 (n = 1)
Number 21: Routine (yearly) re-evaluation of an asymptomatic patient with mild native AS or mild-moderate native MS and no change in clinical status, %11 (n = 18)61 (n = 11)39 (n = 7)33 (n = 6)
Number 25: Routine (yearly) evaluation of native valvular regurgitation in an asymptomatic patient with mild regurgitation, no change in clinical status, and normal LV size, %6 (n = 9)33 (n = 3)22 (n = 2)11 (n = 1)
Number 29: Routine (yearly) evaluation of a patient with a prosthetic valve in whom there is no suspicion of valvular dysfunction and no change in clinical status, %6 (n = 9)44 (n = 4)22 (n = 2)22 (n = 2)
Number 32: Evaluation of native and/or prosthetic valves in patients with transient fever but without evidence of bacteremia or new murmur, %10 (n = 15)27 (n = 4)40 (n = 5)13 (n = 2)
Number 39: Routine evaluation of patients with systemic hypertension without suspected hypertensive heart disease, %2 (n = 3)0 (n = 0)0 (n = 0)0 (n = 0)
Number 40: Re-evaluation of a patient with known hypertensive heart disease without a change in clinical status, %13 (n = 20)40 (n = 8)20 (n = 4)15 (n = 3)
Number 42: Routine (yearly) re-evaluation of patients with heart failure (systolic or diastolic) in whom there is no change in clinical status, %24 (n = 37)68 (n = 25)38 (n = 14)24 (n = 9)
Number 47: Routine (yearly) evaluation of hypertrophic cardiomyopathy in a patient with no change in clinical status, %1 (n = 2)0 (n = 0)50 (n = 1)0 (n = 0)

AS = aortic stenosis; APC = atrial premature contraction; CMR = cardiac magnetic resonance; LV gram = left ventriculogram; MS = mitral stenosis; PVC = premature ventricular contraction; SPECT = single-photon emission computed tomography; other abbreviations as in Tables 2 and 3.