Evaluation of the Application of the ACCF/ASE Appropriateness Criteria for Transesophageal Echocardiography in an Academic Medical Center

Background: The aim of this study was to prospectively evaluate the clinical application of the recently published American College of Cardiology Foundation and American Society of Echocardiography appropriateness criteria (AC) for transesophageal echocardiographic (TEE) imaging at a single-center university hospital. Methods: As outlined in the AC, TEE studies were divided into those performed subsequent to transthoracic echocardiographic imaging (adjunctive TEE studies) and those that were the initial echocardiographic studies for the indications being evaluated (initial TEE studies). Each study was categorized as appropriate, uncertain, or inappropriate, according to the relevant section of the AC, and the study's impact on patient management was determined. Results: Of the 405 studies enrolled, 27% were adjunctive and 73% were initial. Ninety-one percent of TEE studies could be classified by the AC. Overall, 97% of the studies were appropriate, 1% were inappropriate, and 2% were uncertain. Patient management was affected by 94% of appropriate studies but by only 50% of uncertain or inappropriate studies. Conclusions: The AC for TEE imaging can be feasibly applied and encompass the majority of the clinical practice of transesophageal echocardiography in an academic setting. (J Am Soc Echocardiogr 2009; 22: 517-522.)