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Diagnostic echocardiography has been steadily increasing in hospital use over the past decade but may still be underused in cardiac settings where it has the greatest value, a study suggested.

"Between 2001 and 2011, the absolute , respectively," , of Mount Sinai Cardiovascular Institute in New York City, and colleagues reported in the Feb. 9 issue of the Journal of the American College of Cardiology.

However, for the five most common diagnoses in which echo is deemed appropriate, echo use was reported for only 8% of cases in 2010.

And that vast underuse might have had consequences, as the study showed echo use associated with lower odds of inpatient mortality in the following settings:

• Acute myocardial infarction (AMI, adjusted odds ratio 0.74, 95% CI 0.63-0.86)
• Cardiac dysrhythmia (adjusted OR 0.72, 95% CI 0.55-0.94)
• Acute cerebrovascular disease (adjusted OR 0.36, 95% CI 0.31-0.42)
• Congestive heart failure (adjusted OR 0.82, 95% CI 0.72-0.94)
• Sepsis (adjusted OR 0.77, 95% CI 0.70-0.85)

"Because patient selection and appropriate echo use are key to cost efficiency, this study suggests that echo may be underused during critical cardiovascular hospitalizations, most notably in the treatment of AMI," the researchers concluded.

"Surprising" was what , and , both of the Cleveland Clinic, had to say in an accompanying editorial.

"The counterintuitive findings ... debunk the widespread perception of echocardiography overuse," they wrote.

The "apparent protective effect of echocardiography" was not necessarily causal and might be explained by a higher standard of care overall for the patients who did get echo, perhaps facilitated in centers with more subspecialty availability," the editorialists noted.

Although there was no difference in distribution of echocardiography utilization by medical center size, the editorialists noted that the highest rates of echocardiography were on the East Coast, "arguably substantiating that greater availability of subspecialty involvement was an influencing factor in utilization."

"In the meantime, this paper reminds us that underutilization of safe, effective technologies such as echocardiography may also have a broad economic impact and that health care strategies that may limit their utilization should be subjected to clinical trials and the cleansing light of actual data," they concluded.