• Chest · Mar 2019

    Comparative Study

    Diagnostic Accuracy of Critical Care Transesophageal Echocardiography Versus Cardiology-Led Echocardiography in Intensive Care Unit Patients.

    • Vincent Lau, Fran Priestap, Yves Landry, Ian Ball, and Robert Arntfield.
    • Department of Medicine, Division of Critical Care, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada. Electronic address: vinceissaclau@gmail.com.
    • Chest. 2019 Mar 1; 155 (3): 491-501.

    BackgroundCritical care transesophageal echocardiography (ccTEE) performed by intensivists is increasingly used to investigate cardiorespiratory failure in the ICU. Validation of the accuracy of TEE in the hands of intensivists remains largely unknown. The goal of this study was to characterize the diagnostic accuracy of ccTEE.MethodsThis study was a two-center, retrospective comparison between TEE studies performed and interpreted by intensivists and cardiology-led TEE or transthoracic echocardiography (TTE) performed and/or interpreted by cardiologists. The study period was December 2012 to December 2016 for all consecutive ICU patients who received an initial ccTEE and either a cardiology TEE or TTE within 72 h. Using the cardiology-conducted examination as the gold standard, we reported sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of ccTEE.ResultsComparisons between ccTEE and cardiology TEE/TTE performed yielded 56 patients (five ccTEE vs cardiology TEE and 51 ccTEE vs cardiology TTE). The comparison between ccTEE and cardiology TEE showed 100% sensitivity, specificity, PPV, NPV, and accuracy for the primary diagnosis and other major findings. For the combined ccTEE and cardiology TEE/TTE comparison, there was a high sensitivity/specificity/PPV/NPV/accuracy for the primary diagnosis (90%-100% range), as well as other major diagnoses (88%-100% range).ConclusionsThis study showed that ccTEE has a high sensitivity, specificity, PPV, NPV, and accuracy compared with the gold standard cardiology TEE or TTEs in critically ill patients, when performed by advanced echocardiogram-trained/experienced intensivists.Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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