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Peer-reviewedCC BY-NC-NDBMC emergency medicine

Serial cardiac ultrasound in acutely ill adults: a systematic review.

  • Michael Dan Arvig1,2,3
  • Stig Holm Ovesen4,5,6
  • Ronja Leth4,7
  • Mikkel Brabrand8,9
  • Casper Falster10,11
11 affiliations
  1. 1Research Entity for Studies in Clinical aCUte Medicine (RESCUE), Emergency Department, Slagelse Hospital, Ingemannsvej 50, Slagelse, Denmark. [email protected].
  2. 2Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, Copenhagen, Denmark. [email protected].
  3. 3Department of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, Odense, Denmark. [email protected].
  4. 4Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark.
  5. 5Department of Clinical Medicine, Aarhus University Radiology Research Unit (AURA), Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark.
  6. 6Emergency Department, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark.
  7. 7Emergency Department, Horsens Regional Hospital, Horsens Regional Hospital, Sundvej 30, Horsens, Denmark.
  8. 8Emergency Department, Odense University Hospital, Kløvervaenget 25, Odense, Denmark.
  9. 9Research Unit of Emergency Medicine, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, Odense, Denmark.
  10. 10Department of Internal Medicine, Svendborg Hospital, Baagøes Àlle 15, Svendborg, Denmark.
  11. 11Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, Odense, Denmark.
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{arvig2026serial,
  title = {{Serial cardiac ultrasound in acutely ill adults: a systematic review.}},
  author = {Michael Dan Arvig and Stig Holm Ovesen and Ronja Leth and Mikkel Brabrand and Casper Falster},
  journal = {BMC emergency medicine},
  year = {2026},
  month = aug,
  doi = {10.1186/s12873-026-01713-6},
  url = {https://europepmc.org/article/MED/42972234},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Serial cardiac ultrasound in acutely ill adults: a systematic review.
AU  - Michael Dan Arvig
AU  - Stig Holm Ovesen
AU  - Ronja Leth
AU  - Mikkel Brabrand
AU  - Casper Falster
PY  - 2026
DA  - 2026/08/04
JO  - BMC emergency medicine
DO  - 10.1186/s12873-026-01713-6
UR  - https://europepmc.org/article/MED/42972234
AB  - 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.
SN  - 1471-227X
ER  -