Application of the Appropriateness Criteria for Echocardiography in an Academic Medical Center

Niti R. Aggarwal, Punsak Wuthiwaropas, Barry L. Karon, Fletcher A. Miller, Patricia A. Pellikka

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Background: The authors examined the feasibility of application of the American College of Cardiology Foundation's appropriateness criteria for transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) at a large tertiary care practice. Methods: Indications for consecutive TTE and TEE were determined by chart review and classified according to the guidelines as appropriate, inappropriate, or uncertain or, for situations not addressed in the document, nonclassifiable. Results: Of the 529 studies reviewed, 469 were appropriate, 23 inappropriate, 1 uncertain, and 36 nonclassifiable. Inappropriate and nonclassifiable studies were more commonly TTE than TEE (P < .001). Inappropriate studies were more common in outpatients than inpatients (P < .001). Nonclassifiable cases included assessment after radiofrequency ablation (33.3%) and preoperative evaluation (8.3%). Disagreement between observers in selection of the criterion was present in 30.8%. Conclusions: Although the study was conducted retrospectively, only 4.7% of classifiable studies were inappropriate. The reproducibility of classification was moderate, and 6.8% of studies were not classifiable. Areas for improvement of the criteria were identified.

Original languageEnglish (US)
Pages (from-to)267-274
Number of pages8
JournalJournal of the American Society of Echocardiography
Issue number3
StatePublished - Mar 2010


  • Appropriateness
  • Echocardiography
  • Imaging
  • Transesophageal echocardiography
  • Transthoracic echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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