ISSN: 1755-5310 (Electronic)1755-5302 (Print)

Interventional Cardiology

Uremic Cardiomyopathy Review

 Because the growth in utilization of cardiovas-cular (CV) imaging since the 1990s has beenso well documented and thefindings so consis-tent, there is a general assumption that imaging isoverused. Quality improvement efforts in imaginghave  become  nearly  synonymous  with  efforts  toreduce use, whether they areappropriate use criteria(AUC), payer constraints on testing access, or the“Choose Wisely”campaign. Although imagers havecountered with a call to emphasize value rather thanvolume, the message is still essentially the same: doless.  These  efforts  have  been  successful  with  a“bending of the curve”of CV imaging growth begin-ning in 2008(1). However, by limiting quality effortsto overuse, we ignore the very important possibilitythat underuse and misuse can also occur. Further,although overuse may result in a relatively harmlesscollection of redundant information, underuse maybe associated with a failure to acquire critical in-formation and diagnose and treat significant disease,arguably a more important concern. Worse, the effortsto reduce all imaging use could have the unintendedconsequence of reducing needed imaging, exacer-bating the problem of underuse. So, is there evidence of underuse in CV imaging?This  is  a  difficult  question  to  answer.  AUC  andguidelines generally do not address underuse, andthere are few clinical scenarios in which a nationalstandard calls for“must do”imaging. Further imagingoccurs early in the process of symptom evaluation sothat information about the number, characteristics,and outcomes of those who are not imaged is un-available. Nevertheless, there are clues that imagingis, in fact, underutilized in some scenarios. CurrentAUC suggests that use of diagnostic catheterizationand revascularization should be preceded by docu-mentation of ischemia in most cases.  

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