Stone JR, et al. - Consecutive electrocardiograms over 6 months were analyzed to ascertain the prevalence of important transthoracic echocardiographic (TTE) abnormalities in patients with a normal electrocardiographic (ECG) referred for TTE imaging. The study group was formed by patients with a normal ECG who underwent TTE imaging within 30 days. Findings revealed that clinically important TTE abnormalities in patients with a normal ECG were common, proposing that normal ECG results should not routinely preclude TTE imaging to identify structural heart disease, however, recognition of common clinical indications and application of the appropriate use criteria could identify patients with a normal ECG in whom TTE imaging is of very low yield.