TTE, though ‘appropriate,’ changes care in only 32%

This study is commendable, but simply designating a TTE as leading to no change in clinical care or to a continuation of existing care can be misleading. These descriptions imply that there was a total disregard for or ignorance of the TTE results, said Dr. William Armstrong and Dr. Kim A. Eagle.

In this study, TTE was performed in 24 patients receiving cardiotoxic agents, and the response to the TTE results was to continue existing care in 21 of them. But even though management did not change, continued TTE screening represents highly appropriate and highly beneficial state-of-the-art care for such patients, they noted.

Similarly, TTE is "the only realistic method for confirming the presence or absence" of suspected pulmonary hypertension. When this disorder is a legitimate concern but is not found to be present on TTE scanning, "no change" in care is entirely appropriate, Drs. Armstrong and Eagle said.

Dr. Armstrong and Dr. Eagle are in the division of cardiology at the University of Michigan Medical Center, Ann Arbor. They reported no financial conflicts of interest. These remarks were taken from their invited commentary accompanying Dr. Matulevicius’s report (JAMA Intern. Med. 2013 July 22 [doi:10.1001/jamainternmed.2013.7273]).