Serial cardiac ultrasound in acutely ill adults: a systematic review

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Acutely ill adults (n=941). Intervention: Serial cardiac ultrasound. Primary outcome: Mortality, readmission, length of stay, and/or intensive care unit transfer.

Q: What does this research mean for the field?

Serial cardiac ultrasound parameters do not demonstrate a consistent association with mortality, readmission, length of stay, or intensive care unit transfer in acutely ill adults. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

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

doi:10.1186/s12873-026-01713-6

August 4, 2026BMC Emergency MedicineOpen Access

Serial cardiac ultrasound in acutely ill adults: a systematic review

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Key result

Serial cardiac ultrasound fails to predict mortality or clinical outcomes in acutely ill adults.

n=941

Why the study?

Whether serial changes in dynamic cardiac ultrasound parameters are associated with patient outcomes or useful in guiding management in acutely ill adults was uncertain.

Does serial cardiac ultrasound improve mortality, readmissions, length of stay, or intensive care unit transfer in acutely ill adults?

Key Points

To assess whether serial changes in ejection fraction, tricuspid annular plane systolic excursion, and right ventricular-to-left ventricular ratio correlate with mortality, readmissions, length of stay, or intensive care unit transfer in acutely ill adults.
Searched multiple databases through 31 October 2025 for randomized trials, non-randomized trials, and observational studies of acutely ill adults (≥18 years) undergoing at least two in-hospital cardiac ultrasound assessments.
Identified 11 eligible studies comprising 941 patients across diverse clinical conditions, including acute heart failure, pulmonary embolism, sepsis, and COVID-19.
Evaluated risk of bias with design-specific tools and synthesized findings using synthesis without meta-analysis (SWiM).
Across 4 studies evaluating outcomes, serial changes in EF, TAPSE, or RV/LV ratio showed no consistent association with mortality, hospital readmissions, length of stay, or ICU transfer.
One randomized controlled trial assessed ultrasound-guided management against usual care and found no difference in clinical outcomes.
Trajectories of cardiac ultrasound parameters generally remained stable or improved across admissions, though the overall risk of bias across studies was moderate to high.

Study Design

Type

Systematic Review (n=941)

Structured PICO

Does serial cardiac ultrasound improve mortality, readmissions, length of stay, or intensive care unit transfer in acutely ill adults?

P

Population

941 acutely ill adults across 11 studies who underwent at least two in-hospital cardiac ultrasound assessments to evaluate associations with clinical outcomes.

E

Exposure

Serial in-hospital cardiac ultrasound assessments (typically 3-4 scans during admission) evaluating dynamic changes in ejection fraction (EF), tricuspid annular plane systolic excursion (TAPSE), and right ventricular-to-left ventricular (RV/LV) ratio.

C

Comparator

Usual care (in 1 randomized controlled trial) or no comparator (in observational studies).

O

Outcome

Mortality, readmission, length of stay, and/or intensive care unit transfer.hard clinical

Limitations

Non-standardized serial cardiac ultrasound exposure across studies
Sparse and inconsistent outcome reporting across studies
Most studies were small and non-randomized, with a moderate-to-serious risk of bias
Clinical utility must be established as only one randomized trial evaluated an ultrasound-guided treatment algorithm
External validity is limited as most cohorts were single-center hospital studies in high-income settings
Selection bias and reporting bias cannot be excluded
Small single-center cohorts
Heterogeneous scanning protocols and timing
Moderate to high risk of bias across included studies
Sparse and inconsistent outcome reporting precluding meta-analysis
Potential selection and reporting bias

Implication

Serial cardiac ultrasound parameters in acutely ill adults do not show a consistent association with clinical outcomes, highlighting the need for trials evaluating decision-linked ultrasound-guided management.

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 This Study

Arvig et al. (2026) conducted a systematic review in Acutely ill adults (n=941). Serial cardiac ultrasound was evaluated on Mortality, readmission, length of stay, and/or intensive care unit transfer. Serial cardiac ultrasound parameters did not demonstrate a consistent association with mortality, readmission, length of stay, or intensive care unit transfer in acutely ill adults.

synapsesocial.com/papers/6a74374b764cddc9499d4816 https://doi.org/10.1186/s12873-026-01713-6

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Serial cardiac ultrasound in acutely ill adults: a systematic review

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Serial cardiac ultrasound in acutely ill adults: a systematic review

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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