Trends in the Use of Echocardiography and Left Ventriculography in Patients Hospitalized with Acute Myocardial Infarction: The Worcester Heart Attack Study
Department of Medicine, Division of Cardiovascular Medicine
Goldberg, Robert J.
Myocardial Infarction; Stroke Volume; Echocardiography; Radionuclide Ventriculography; Worcester (Mass.)
Life Sciences | Medicine and Health Sciences
Background: Current guidelines strongly recommend the measurement of ejection fraction (EF) in all patients hospitalized with acute myocardial infarction (AMI). Over the past decade, the modalities and timing of tests used to evaluate EF in patients hospitalized with AMI have changed significantly, though there are little data available describing evolving trends in the use of these diagnostic modalities.
Purpose: The purpose of this study was to evaluate changing trends in the use of left ventriculography and echocardiography to measure EF in patients hospitalized with AMI.
Methods: The study sample consisted of 5,385 residents of the Worcester, MA metropolitan area hospitalized with AMI in 5 annual periods between 1997 and 2005. Patients were classified into 4 mutually exclusive categories based on the tests that they received to determine EF: Echocardiography only, ventriculography only, neither, or both. Univariate and multivariate methods were used to characterize differences between the groups.
Results: Between 1997 and 2005, the proportion of patients hospitalized with AMI undergoing measurement of EF by both ventriculography and echocardiography increased from 11% to 18%, while the percentage of patients who did not receive an evaluation of EF by either modality decreased from 37% to 27%. The percentage of patients undergoing measurement of EF by ventriculography alone increased from 15% to 20%, while the percentage of patients undergoing measurement of EF by echocardiography alone was stable at approximately 37%. In 1997, echocardiography was performed prior to ventriculography in approximately two-thirds of patients, while in 2005 ventriculography was performed prior to echocardiography in approximately two-thirds of patients.
Conclusions: Our results suggest that the use of ventriculography, and the duplicative use of both ventriculography and echocardiography, to assess EF in patients hospitalized with AMI are increasing. While the proportion of AMI patients who do not have their EF assessed has declined significantly during recent years, approximately one-quarter of all AMI patients still do not receive this important test.
DOI of Published Version
This research was eventually published as follows: Samuel W. Joffe, Armen Chalian, Dennis A. Tighe, Gerard P. Aurigemma, Jorge Yarzebski, Joel M. Gore, Darleen Lessard, Robert J. Goldberg, Trends in the use of echocardiography and left ventriculography to assess left ventricular ejection fraction in patients hospitalized with acute myocardial infarction, American Heart Journal, Volume 158, Issue 2, August 2009, Pages 185-192. Link to article on publisher's website
American Heart Journal
Chalian, Armen; Tighe, Dennis A.; Aurigemma, Gerard P.; Yarzebski, Jorge; Gore, Joel M.; Lessard, Darleen
Joffe, Samuel W., "Trends in the Use of Echocardiography and Left Ventriculography in Patients Hospitalized with Acute Myocardial Infarction: The Worcester Heart Attack Study" (2008). University of Massachusetts Medical School. Senior Scholars Program. Paper 67.