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Background <p>Cardiopulmonary symptoms frequently prompt emergency department (ED) visits. Serial as-sessment of dynamic cardiac ultrasound parameters may support monitoring, but their asso-ciation with patient outcomes and role in guiding management is uncertain. This systematic review evaluated whether serial changes in ejection fraction (EF), tricuspid annular plane systolic excursion (TAPSE), and the right ventricular-to-left ventricular (RV/LV) ratio are associated with mortality, readmissions, length of stay, or intensive care unit trans-fer in acutely ill patients.</p> Methods <p>We searched MEDLINE (PubMed), Embase (Ovid), CENTRAL (Wiley), Scopus (Elsevier), Web of Science (Clarivate), Google Scholar, ProQuest, ClinicalTrials.gov, and the International Clini-cal Trials Registry Platform. The initial search was conducted on 16 April 2024 and updated on 31 October 2025. We included randomized and non-randomized trials and observational stud-ies of adults (≥18 years) undergoing at least two in-hospital cardiac ultrasound assessments and reported mortality, readmission, length of stay, and/or intensive care unit transfer. Risk of bias was assessed with study design-specific tools. Results were summarized using synthesis without meta-analysis (SWiM).</p> Results <p>Of 15,174 screened records, 11 studies with a total of 941 patients were included. Study popu-lations were defined by presenting symptoms (dyspnea, hypotension) or by clinical conditions (toxicological, infectious, and cardiopulmonary diseases). Echocardiography was most used, and patients underwent 3–4 scans during admission. Overall risk of bias was moderate to high. Four studies compared serial changes in EF, TAPSE, and/or the RV/LV ratio with outcomes and found no consistent pattern. One randomized study evaluated ultrasound-guided treatment and found no difference compared with usual care. Across studies, EF, TAPSE, and RV/LV ratio were generally stable or improved over time.</p> Conclusion <p>Available evidence is limited and does not demonstrate a consistent association between serial cardiac ultrasound parameters and outcomes in acutely ill adults. However, serial changes are frequently observed, highlighting the need for trials evaluating whether decision-linked, ultrasound-guided management strategies can improve outcomes.</p> Systematic review registration number <p>PROSPERO, CRD42024524740.</p>

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Serial cardiac ultrasound in acutely ill adults: a systematic review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月4日

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  • Michael Dan Arvig,
  • Stig Holm Ovesen,
  • Ronja Leth,
  • Mikkel Brabrand,
  • Casper Falster

摘要

Background

Cardiopulmonary symptoms frequently prompt emergency department (ED) visits. Serial as-sessment of dynamic cardiac ultrasound parameters may support monitoring, but their asso-ciation with patient outcomes and role in guiding management is uncertain. This systematic review evaluated whether serial changes in ejection fraction (EF), tricuspid annular plane systolic excursion (TAPSE), and the right ventricular-to-left ventricular (RV/LV) ratio are associated with mortality, readmissions, length of stay, or intensive care unit trans-fer in acutely ill patients.

Methods

We searched MEDLINE (PubMed), Embase (Ovid), CENTRAL (Wiley), Scopus (Elsevier), Web of Science (Clarivate), Google Scholar, ProQuest, ClinicalTrials.gov, and the International Clini-cal Trials Registry Platform. The initial search was conducted on 16 April 2024 and updated on 31 October 2025. We included randomized and non-randomized trials and observational stud-ies of adults (≥18 years) undergoing at least two in-hospital cardiac ultrasound assessments and reported mortality, readmission, length of stay, and/or intensive care unit transfer. Risk of bias was assessed with study design-specific tools. Results were summarized using synthesis without meta-analysis (SWiM).

Results

Of 15,174 screened records, 11 studies with a total of 941 patients were included. Study popu-lations were defined by presenting symptoms (dyspnea, hypotension) or by clinical conditions (toxicological, infectious, and cardiopulmonary diseases). Echocardiography was most used, and patients underwent 3–4 scans during admission. Overall risk of bias was moderate to high. Four studies compared serial changes in EF, TAPSE, and/or the RV/LV ratio with outcomes and found no consistent pattern. One randomized study evaluated ultrasound-guided treatment and found no difference compared with usual care. Across studies, EF, TAPSE, and RV/LV ratio were generally stable or improved over time.

Conclusion

Available evidence is limited and does not demonstrate a consistent association between serial cardiac ultrasound parameters and outcomes in acutely ill adults. However, serial changes are frequently observed, highlighting the need for trials evaluating whether decision-linked, ultrasound-guided management strategies can improve outcomes.

Systematic review registration number

PROSPERO, CRD42024524740.