Cardiology fellows’ HHU image quality and effect of HHU results
on clinical decision making:
To describe their image quality, cardiology fellows gave a score to
segmental endocardial border visualization (2 = good, 1 = poor, 0 =
invisible). The mean endocardial visibility grade was 1.41 ± 0.58. When
asked to rate their level of confidence interpreting the study (2 =
confident, 1 = intermediate, 0 = uncertain), the mean level of
confidence was 1.30 ± 0.67. Fellows were also able to recognize
pericardial effusions, identifying eight patients with small effusions
on HHU of which all were confirmed with TTE.
Fellows reported that in 32% of the patients, the HHU study influenced
their clinical decision making (Table 3). This was corroborated with
several objective findings. First, patients with WMA on HHU were more
likely to undergo invasive angiography during hospitalization (96% vs
75%, p<0.01). Second: the mean time-to-cath in patient with
abnormal HHU findings of WMA tended to be shorter than among patients
without WMA (58 ± 32 minutes versus 218 ± 388 min, p=0.06). Finally,
among patients undergoing angiography, those with WMA were more likely
to undergo an angiogram within 90 minutes of presentation (96% vs 66%,
p<0.001).