REVISIÓN DE LAS

INDICACIONES DE
ECOCARDIOGRAFÍA
JENCY FERNANDA PEDRAZA CHAPARRO
ROTACIÓN DE CARDIOLOGÍA PEDIÁTRICA
RESIDENTE DE PEDIATRIA 2 AÑO
HOSPITAL UNIVERSITARIO CLÍNICA SAN RAFAEL
UMNG 2023
ECOCARDIOGRAMA

¿CUÁLES SON LAS

INDICACIONES MÁS
FRECUENTES EN LA
SOLICITUD DE
ECOCARDIOGRAMAS?
ECOCARDIOGRAMA
Extendida, es fácil de usar y presenta un riesgo insignificante
113 INDICACIONES: CACP -> Indicaciones de uso apropiado

Writing Group for Echocardiography in Outpatient Pediatric Cardiology; Campbell RM, Douglas PS, Eidem BW, Lai WW, Lopez L, Sachdeva R; American College of Cardiology Appropriate Use Criteria Task Force; American Academy of Pediatrics; American Heart Association; American Society of Echocardiography; Heart
Rhythm Society; Society for Cardiovascular Angiography and Interventions; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance; Society of Pediatric Echocardiography. ACC/AAP/AHA/ASE/HRS/SCAI/SCCT/SCMR/SOPE 2014 appropriate use criteria for initial transthoracic
echocardiography in outpatient pediatric cardiology: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Academy of Pediatrics, American Heart Association, American Society of Echocardiography, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions,
Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Pediatric Echocardiography. J Am Soc Echocardiogr. 2014 Dec;27(12):1247-66. doi: 10.1016/j.echo.2014.10.002. PMID: 25479897.
 ECOCARDIOGRAMA

Writing Group for Echocardiography in Outpatient Pediatric Cardiology; Campbell RM, Douglas PS, Eidem BW, Lai WW, Lopez L, Sachdeva R; American College of Cardiology Appropriate Use Criteria Task Force; American Academy of Pediatrics; American Heart Association; American Society of Echocardiography; Heart Rhythm Society; Society for Cardiovascular Angiography and
Interventions; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance; Society of Pediatric Echocardiography. ACC/AAP/AHA/ASE/HRS/SCAI/SCCT/SCMR/SOPE 2014 appropriate use criteria for initial transthoracic echocardiography in outpatient pediatric cardiology: a report of the American College of Cardiology Appropriate Use Criteria Task
Force, American Academy of Pediatrics, American Heart Association, American Society of Echocardiography, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Pediatric Echocardiography. J Am Soc Echocardiogr. 2014 Dec;27(12):1247-66. doi:
10.1016/j.echo.2014.10.002. PMID: 25479897.
 ECOCARDIOGRAMA

Writing Group for Echocardiography in Outpatient Pediatric Cardiology; Campbell RM, Douglas PS, Eidem BW, Lai WW, Lopez L, Sachdeva R; American College of Cardiology Appropriate Use Criteria Task Force; American Academy of Pediatrics; American Heart Association; American Society of Echocardiography; Heart Rhythm Society; Society for Cardiovascular Angiography and
Interventions; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance; Society of Pediatric Echocardiography. ACC/AAP/AHA/ASE/HRS/SCAI/SCCT/SCMR/SOPE 2014 appropriate use criteria for initial transthoracic echocardiography in outpatient pediatric cardiology: a report of the American College of Cardiology Appropriate Use Criteria Task
Force, American Academy of Pediatrics, American Heart Association, American Society of Echocardiography, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Pediatric Echocardiography. J Am Soc Echocardiogr. 2014 Dec;27(12):1247-66. doi:
10.1016/j.echo.2014.10.002. PMID: 25479897.
ECOCARDIOGRAMA

Writing Group for Echocardiography in Outpatient Pediatric Cardiology; Campbell RM, Douglas PS, Eidem BW, Lai WW, Lopez L, Sachdeva R; American College of Cardiology Appropriate Use Criteria Task Force; American Academy of Pediatrics; American Heart Association; American Society of Echocardiography; Heart Rhythm Society;
Society for Cardiovascular Angiography and Interventions; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance; Society of Pediatric Echocardiography. ACC/AAP/AHA/ASE/HRS/SCAI/SCCT/SCMR/SOPE 2014 appropriate use criteria for initial transthoracic echocardiography in outpatient
pediatric cardiology: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Academy of Pediatrics, American Heart Association, American Society of Echocardiography, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography,
Society for Cardiovascular Magnetic Resonance, and Society of Pediatric Echocardiography. J Am Soc Echocardiogr. 2014 Dec;27(12):1247-66. doi: 10.1016/j.echo.2014.10.002. PMID: 25479897.
 ECOCARDIOGRAMA

Writing Group for Echocardiography in Outpatient Pediatric Cardiology; Campbell RM, Douglas PS, Eidem BW, Lai WW, Lopez L, Sachdeva R; American College of Cardiology Appropriate Use Criteria Task Force; American Academy of Pediatrics; American Heart Association; American Society of Echocardiography; Heart Rhythm Society; Society for Cardiovascular Angiography and
Interventions; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance; Society of Pediatric Echocardiography. ACC/AAP/AHA/ASE/HRS/SCAI/SCCT/SCMR/SOPE 2014 appropriate use criteria for initial transthoracic echocardiography in outpatient pediatric cardiology: a report of the American College of Cardiology Appropriate Use Criteria Task
Force, American Academy of Pediatrics, American Heart Association, American Society of Echocardiography, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Pediatric Echocardiography. J Am Soc Echocardiogr. 2014 Dec;27(12):1247-66. doi:
10.1016/j.echo.2014.10.002. PMID: 25479897.
ECOCARDIOGRAMA

1. De los 2655 estudios solicitados por 102 médicos, se encontraron indicaciones clasificadas A, M y R en 1876 (71
%), 316 (12 %) y 319 estudios (12 %), respectivamente, y 144 estudios (5 %) fueron inclasificable

2. Veinticuatro de 113 indicaciones (21%) no se utilizaron.

3. Un soplo inocente y síncope o palpitaciones sin otros indicios de enfermedad cardiovascular, antecedentes
familiares benignos y electrocardiograma normal representaron el 75 % de las indicaciones clasificadas
como R.

4. El soplo patológico tuvo el mayor rendimiento de hallazgos anormales (40 %).

5. Las probabilidades de un hallazgo anormal en un ETT A o M fueron 6 veces mayores que las de R (intervalo
de confianza [IC] del 95 %: [2,8 a 12,8]).

6. Los hallazgos anormales fueron más comunes en pacientes <1 año de edad que en los mayores de 10 años
(odds ratio: 6,4; IC del 95 %: 4,7 a 8,7).
 ECOCARDIOGRAMA

Sachdeva R, Allen J, Benavidez OJ, Campbell RM, Douglas PS, Eidem BW, Gold L, Kelleman MS, Lopez L, McCracken CE, Stern KW, Weiner RB, Welch E, Lai WW. Pediatric Appropriate Use Criteria Implementation Project: A Multicenter Outpatient Echocardiography Quality Initiative. J Am Coll Cardiol. 2015 Sep 8;66(10):1132-40. doi: 10.1016/j.jacc.2015.06.1327. Erratum in: J Am
Coll Cardiol. 2016 Apr 5;67(13):1660. PMID: 26337992.
 ECOCARDIOGRAMA

Sachdeva R, Allen J, Benavidez OJ, Campbell RM, Douglas PS, Eidem BW, Gold L, Kelleman MS, Lopez L, McCracken CE, Stern KW, Weiner RB, Welch E, Lai WW. Pediatric Appropriate Use Criteria Implementation Project: A Multicenter Outpatient Echocardiography Quality Initiative. J Am Coll Cardiol. 2015 Sep 8;66(10):1132-40. doi: 10.1016/j.jacc.2015.06.1327. Erratum in: J Am
Coll Cardiol. 2016 Apr 5;67(13):1660. PMID: 26337992.
 ECOCARDIOGRAMA

Sachdeva R, Allen J, Benavidez OJ, Campbell RM, Douglas PS, Eidem BW, Gold L, Kelleman MS, Lopez L, McCracken CE, Stern KW, Weiner RB, Welch E, Lai WW. Pediatric Appropriate Use Criteria Implementation Project: A Multicenter Outpatient Echocardiography Quality Initiative. J Am Coll Cardiol. 2015 Sep 8;66(10):1132-40. doi: 10.1016/j.jacc.2015.06.1327. Erratum in: J Am
Coll Cardiol. 2016 Apr 5;67(13):1660. PMID: 26337992.
 ECOCARDIOGRAMA

Sachdeva R, Allen J, Benavidez OJ, Campbell RM, Douglas PS, Eidem BW, Gold L, Kelleman MS, Lopez L, McCracken CE, Stern KW, Weiner RB, Welch E, Lai WW. Pediatric Appropriate Use Criteria Implementation Project: A Multicenter Outpatient Echocardiography Quality Initiative. J Am Coll Cardiol. 2015 Sep 8;66(10):1132-40. doi: 10.1016/j.jacc.2015.06.1327. Erratum in: J Am
Coll Cardiol. 2016 Apr 5;67(13):1660. PMID: 26337992.
 ECOCARDIOGRAMA

Sachdeva R, Allen J, Benavidez OJ, Campbell RM, Douglas PS, Eidem BW, Gold L, Kelleman MS, Lopez L, McCracken CE, Stern KW, Weiner RB, Welch E, Lai WW. Pediatric Appropriate Use Criteria Implementation Project: A Multicenter Outpatient Echocardiography Quality Initiative. J Am Coll Cardiol. 2015 Sep 8;66(10):1132-40. doi: 10.1016/j.jacc.2015.06.1327. Erratum in: J Am
Coll Cardiol. 2016 Apr 5;67(13):1660. PMID: 26337992.
ECOCARDIOGRAMA
ECOCARDIOGRAMA

1. La concordancia entre el AUC y la utilización de TTE fue del 88 %.

2. El TTE se realizó para indicaciones raramente apropiadas en el 9 % y se asoció con la
edad del paciente < 3 meses, indicaciones de soplo, subespecialidad del médico de
imágenes no invasivas y volumen del médico.
3. No se solicitó ETT por indicaciones apropiadas en el 3 % y se asoció con indicaciones
que incluían resultados de pruebas anteriores (principalmente hallazgos
electrocardiográficos anormales), pacientes de edad avanzada y subespecialidades
médicas distintas a las generales o de imagenología.
4. Hubo una gran variabilidad en la utilización de TTE entre los centros.

Stern KWD, Gulesserian T, Choi J, Lang SM, Statile CJ, Michelfelder EC, McLaughlin ES, Nguyen T, Lopez L, Verghese GR, Hsu DT, Sachdeva R. Factors Influencing Pediatric Outpatient Transthoracic Echocardiography Utilization Before Appropriate Use Criteria Release: A Multicenter Study. J Am Soc Echocardiogr. 2017 Dec;30(12):1225-1233. doi:
10.1016/j.echo.2017.08.015. PMID: 29202952.
ECOCARDIOGRAMA

Stern KWD, Gulesserian T, Choi J, Lang SM, Statile CJ, Michelfelder EC, McLaughlin ES, Nguyen T, Lopez L, Verghese GR, Hsu DT, Sachdeva R. Factors Influencing Pediatric Outpatient Transthoracic Echocardiography Utilization Before Appropriate Use Criteria Release: A Multicenter Study. J Am Soc Echocardiogr. 2017 Dec;30(12):1225-1233. doi:
10.1016/j.echo.2017.08.015. PMID: 29202952.
 ECOCARDIOGRAMA
Se evaluó la TTE pediátrica ambulatoria inicial solicitada
por cardiólogos pediátricos entre enero y marzo de 2014
en un consultorio comunitario (Packard Children's Health
Alliance [PCHA]; n = 238) y un centro terciario académico
(Lucile Packard Children's Hospital [LPCH]; n = 76 ) basado
en los criterios de uso apropiado (AUC) publicados en
diciembre de 2014.

1. De 314 TTE, 165 (52,5 %) se clasificaron como “apropiados”, 40 (12,7 %) se clasificaron como “puede
ser apropiado”, 100 (31,9 %) se clasificaron como “rara vez apropiado” y 9 (2,9 %) fueron
inclasificable
2. La proporción de hallazgos anormales no difirió entre los 2 entornos de práctica (5,3 % para LPCH
frente a 7,6 % para PCHA; P = 0,61).
3. Las ETT realizadas en PCHA tenían significativamente más probabilidades de ser "rara vez
apropiadas" (OR, 2,57; IC del 95 %, 1,28-5,15; P = 0,008). Niños <1 año (OR, 1,90; IC 95 %, 1,03-3,50; P = 0,04)
y proveedores solicitantes con <10 años desde la finalización de su beca (OR, 2,15; IC 95 %, 1,20-3,87; P
= .01) se asociaron con indicaciones "rara vez apropiadas".
4. Los ETT "apropiados" se asociaron con hallazgos anormales (OR, 8,69; IC del 95 %, 1,77-42,68; P =
0,008).
ECOCARDIOGRAMA

Balasubramanian S, Ramirez FD, Bui Y, Selamet Tierney ES, Behera SK. Comparison of Initial Pediatric Outpatient Echocardiogram Indications between Community and Academic Practice. J Pediatr. 2019 Apr;207:23-28.e2. doi: 10.1016/j.jpeds.2018.11.057. Epub 2019 Jan 17. PMID: 30661793.
 ECOCARDIOGRAMA

• De los 441 pacientes atendidos por telesalud, rango intercuartílico de 1,9 a 15,3 años, 114 (26%)
pacientes fueron derivados para ecocardiograma.
• De los pacientes a los que se les solicitó ecocardiograma, 56/114 (49%) eran nuevos en
cardiología.
• Los ecocardiogramas fueron calificados: A-85 (75%), M-5 (4%) y R-24 (21%).
• De los 108 estudios completados, 61 (56%) fueron normales, 44 (41%) fueron anormales y tres
(3%) indeterminados.
• No se detectaron hallazgos anormales de TTE en los encuentros R en comparación con hallazgos
anormales en 46/82 (56 %) de los estudios completados.
Kernizan D, Srivastava S, Nigam P, Geary EM, Baker-Smith C. Telehealth and Application of Appropriate Use Criteria for Pediatric Transthoracic Echocardiography. Pediatr Cardiol. 2022 Aug 12:1–7. doi: 10.1007/s00246-022-02985-y. Epub ahead of print. PMID: 35962201; PMCID: PMC9374290.
ECOCARDIOGRAMA

Kernizan D, Srivastava S, Nigam P, Geary EM, Baker-Smith C. Telehealth and Application of Appropriate Use Criteria for Pediatric Transthoracic Echocardiography. Pediatr Cardiol. 2022 Aug 12:1–
7. doi: 10.1007/s00246-022-02985-y. Epub ahead of print. PMID: 35962201; PMCID: PMC9374290.
ECOCARDIOGRAMA
Aunque el ecocardiograma ofrece muchos
beneficios, también es importante considerar:
- los costos
- los recursos disponibles relacionados con FE.

FE es un proceso que requiere mucha mano de

obra, con muchos exámenes que tardan de 20 a 60
minutos.

Dado que hay un número limitado de especialistas

que brindan FE en relación con el personal se
reserva en gran medida para indicaciones
apropiadas.

Kernizan D, Srivastava S, Nigam P, Geary EM, Baker-Smith C. Telehealth and Application of Appropriate Use Criteria for Pediatric Transthoracic Echocardiography. Pediatr Cardiol. 2022 Aug 12:1–7. doi: 10.1007/s00246-022-02985-y. Epub ahead of print. PMID: 35962201; PMCID: PMC9374290.
ECOCARDIOGRAMA

Sociedad de Medicina de Cuidados Críticos, es

decir, intensivistas quirúrgicos, médicos,
pediátricos y anestésicos. Un metodólogo e
intensivista (ME) apoyó al grupo.

Levitov A, Frankel HL, Blaivas M, Kirkpatrick AW, Su E, Evans D, Summerfield DT, Slonim A, Breitkreutz R, Price S, McLaughlin M, Marik PE, Elbarbary M. Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients-Part II: Cardiac Ultrasonography. Crit Care Med. 2016 Jun;44(6):1206-27. doi:
10.1097/CCM.0000000000001847. PMID: 27182849.
ECOCARDIOGRAMA

Levitov A, Frankel HL, Blaivas M, Kirkpatrick AW, Su E, Evans D, Summerfield DT, Slonim A, Breitkreutz R, Price S, McLaughlin M, Marik PE, Elbarbary M. Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients-Part II: Cardiac Ultrasonography. Crit Care Med. 2016 Jun;44(6):1206-27. doi:
10.1097/CCM.0000000000001847. PMID: 27182849.
ECOCARDIOGRAMA

Levitov A, Frankel HL, Blaivas M, Kirkpatrick AW, Su E, Evans D, Summerfield DT, Slonim A, Breitkreutz R, Price S, McLaughlin M, Marik PE, Elbarbary M. Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients-Part II: Cardiac Ultrasonography. Crit Care Med. 2016 Jun;44(6):1206-27. doi:
10.1097/CCM.0000000000001847. PMID: 27182849.
ECOCARDIOGRAMA
• Criterio basado en evidencia clínica.

• Los antecedentes familiares de CHD, así

como los factores maternos (p. ej.,
diabetes, autoanticuerpos, exposición a
teratógenos) y fetales (p. ej., sospecha de
CHD en ecografía obstétrica, arritmias,
anomalías no cardíacas) confieren un
mayor riesgo de FHD y se han reconocido
como indicaciones válidas para ET
referencia en las guías publicadas.

Levitov A, Frankel HL, Blaivas M, Kirkpatrick AW, Su E, Evans D, Summerfield DT, Slonim A, Breitkreutz R, Price S, McLaughlin M, Marik PE, Elbarbary M. Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients-Part II: Cardiac Ultrasonography. Crit Care Med. 2016 Jun;44(6):1206-27. doi:
10.1097/CCM.0000000000001847. PMID: 27182849.
GRACIAS
 BIBLIOGRAFÍA
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• Kernizan D, Srivastava S, Nigam P, Geary EM, Baker-Smith C. Telehealth and Application of Appropriate Use Criteria for Pediatric Transthoracic Echocardiography.
Pediatr Cardiol. 2022 Aug 12:1–7. doi: 10.1007/s00246-022-02985-y. Epub ahead of print. PMID: 35962201; PMCID: PMC9374290.
• Stern KWD, Gulesserian T, Choi J, Lang SM, Statile CJ, Michelfelder EC, McLaughlin ES, Nguyen T, Lopez L, Verghese GR, Hsu DT, Sachdeva R. Factors
Influencing Pediatric Outpatient Transthoracic Echocardiography Utilization Before Appropriate Use Criteria Release: A Multicenter Study. J Am Soc Echocardiogr.
2017 Dec;30(12):1225-1233. doi: 10.1016/j.echo.2017.08.015. PMID: 29202952.
• Ramirez-Suarez KI, Tierradentro-García LO, Otero HJ, Rapp JB, White AM, Partington SL, Harris MA, Vatsky SA, Whitehead KK, Fogel MA, Biko DM. Optimizing
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• Balasubramanian S, Ramirez FD, Bui Y, Selamet Tierney ES, Behera SK. Comparison of Initial Pediatric Outpatient Echocardiogram Indications between Community
and Academic Practice. J Pediatr. 2019 Apr;207:23-28.e2. doi: 10.1016/j.jpeds.2018.11.057. Epub 2019 Jan 17. PMID: 30661793.Sachdeva R, Allen J, Benavidez OJ,
Campbell RM, Douglas PS, Eidem BW, Gold L, Kelleman MS, Lopez L, McCracken CE, Stern KW, Weiner RB, Welch E, Lai WW. Pediatric Appropriate Use
Criteria Implementation Project: A Multicenter Outpatient Echocardiography Quality Initiative. J Am Coll Cardiol. 2015 Sep 8;66(10):1132-40. doi:
10.1016/j.jacc.2015.06.1327. Erratum in: J Am Coll Cardiol. 2016 Apr 5;67(13):1660. PMID: 26337992.
• Doniger SJ. Bedside emergency cardiac ultrasound in children. J Emerg Trauma Shock. 2010 Jul;3(3):282-91. doi: 10.4103/0974-2700.66535. PMID: 20930974;
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• Rose-Felker K, Kelleman MS, Campbell RM, Oster ME, Sachdeva R. Appropriate Use and Clinical Impact of Echocardiographic "Evaluation of Murmur" in
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• Levitov A, Frankel HL, Blaivas M, Kirkpatrick AW, Su E, Evans D, Summerfield DT, Slonim A, Breitkreutz R, Price S, McLaughlin M, Marik PE, Elbarbary M.
Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients-Part II: Cardiac Ultrasonography. Crit
Care Med. 2016 Jun;44(6):1206-27. doi: 10.1097/CCM.0000000000001847. PMID: 27182849.

• .