Background
Increased body mass index (BMI) may reduce transthoracic echocardiogram (TTE) image
quality, resulting in increased requirements for ultrasound enhancing agents (UEA),
as recommended by the American Society of Echocardiography (ASE), and a greater incidence
of non-diagnostic studies.
Methods
Over a 5-month period 1,108 TTEs were analysed as to (1) whether they could answer
the clinical question posed by the ordering physician (i.e. were diagnostic vs non
diagnostic), and (2) whether they required UEAs according to the ASE guidelines. Patient
characteristics were gathered from the medical record.
Results
12.9% of TTEs were non-diagnostic (21.0% of TTEs in the obese population [BMI≥30 kg/m2] vs 7.8% in the non-obese [p<0.001]). Predictors of a non-diagnostic study were BMI
(OR 1.09, [95% CI 1.06–1.11], p<0.0001), male gender (OR 1.54, [1.06–2.25], p=0.02),
and inpatient status (OR 1.75, [1.20–2.55], p=0.004). Obesity (BMI≥30) was strongly
associated with non-diagnostic studies (OR 3.22, [2.23–4.51], p<0.001). Factors associated
with increased requirement of UEAs were BMI (OR 1.10, [1.08–1.12], p<0.0001), age
(OR 1.02, [1.01–1.03], p<0.0001) and inpatient status (OR 1.7, [1.29–2.24], p<0.05).
Obesity (BMI>30) was strongly associated with contrast requirement (OR 3.16, [2.43–4.10],
p<0.0001).
Conclusions
Body mass index, male gender and inpatient status were associated with an increased
incidence of non-diagnostic studies. Body mass index, age and inpatient status were
associated with an increased requirement for UEAs.
Keywords
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Article info
Publication history
Published online: August 06, 2021
Accepted:
June 23,
2021
Received in revised form:
April 25,
2021
Received:
October 5,
2020
Identification
Copyright
© 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
