Author + information
- E. Philip Lehmana,b,
- Patricia Cowpera,b,
- Tiffany Randolpha,b,
- Andrzej Kosinskia,b,
- Ranato D. Lopesa,b and
- Pamela Douglasa,b
Background: In patients with an ejection fraction (EF) ≤35%, contrast is often used in transthoracic echocardiography to improve detection of left ventricular thrombus (LVT). Clinical and economic outcomes of a universal contrast use strategy are uncertain.
Methods: A decision analytic model was created to estimate survival, cost and cost-effectiveness of a diagnostic strategy of universal use of contrast echo (vs. echo without contrast) in patients with reduced EF. Echo sensitivity and specificity were estimated with meta-analyses; other model inputs were based on literature. Deterministic and probabilistic sensitivity analyses were performed.
Results: LVT prevalence in patients with reduced EF was 7.9%. Echo sensitivity for LVT with and without contrast was 75% and 51%, respectively; specificity was 99% and 94%. Universal contrast use did not result in clinical or statistical differences in estimated life years, quality adjusted life years, or cost (Table), and were associated with considerable uncertainty. Cost-effectiveness improved marginally with increased LVT prevalence, increased contrast sensitivity, and deceased contrast cost.
Conclusions: A model evaluating routine use of contrast to detect LVT found no benefit in this patient cohort with reduced EF. Given variability in patient characteristics as well as competing risks in the heart failure population, optimal test selection for individuals may vary.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Insights From Echocardiography Use
Abstract Category: 28. Non Invasive Imaging: Echo
Presentation Number: 1291-229
- 2017 American College of Cardiology Foundation