EXPEDITED PUBLICATION
Impact of Contrast Echocardiography on Evaluation of Ventricular Function and Clinical Management in a Large Prospective Cohort
Mustafa Kurt, MD,
Kamran A. Shaikh, MD,
Leif Peterson, PhD,
Karla M. Kurrelmeyer, MD, FACC,
Gopi Shah, MD, FACC,
Sherif F. Nagueh, MD, FACC,
Robert Fromm, MD,
Miguel A. Quinones, MD, FACC and
William A. Zoghbi, MD, FACC*
Department of Cardiology, The Methodist Hospital, and The Methodist DeBakey Heart and Vascular Center Imaging Institute, Houston, Texas
Manuscript received September 18, 2008;
revised manuscript received January 6, 2009,
accepted January 12, 2009.
* Reprint requests and correspondence: Dr. William A. Zoghbi, Cardiovascular Imaging Institute, The Methodist DeBakey Heart and Vascular Center, 6550 Fannin Street SM677, Houston, Texas 77030 (Email: wzoghbi{at}tmhs.org).
This study was presented in part at the 57th Annual Scientific Sessions of the American College of Cardiology, March 31, 2008, Chicago, Illinois.
Objectives: The aim of this study was to evaluate the impact of echocardiographic contrast utilization on patient diagnosis and management.
Background: Contrast echocardiography (CE) has improved visualization of endocardial borders. However, its impact on patient management has not been evaluated previously.
Methods: We prospectively enrolled 632 consecutive patients with technically difficult echocardiographic studies who received intravenous contrast (Definity, Lantheus Medical Imaging, Billerica, Massachusetts). Quality of studies, number of left ventricular (LV) segments visualized, estimated ejection fraction, presence of apical thrombus, and management decisions were compared before and after contrast.
Results: After CE, the percent of uninterpretable studies decreased from 11.7% to 0.3% and technically difficult studies decreased from 86.7% to 9.8% (p < 0.0001). Before contrast, 11.6 ± 3.3 of 17 LV segments were seen, which improved after CE to 16.8 ± 1.1 (p < 0.0001). An LV thrombus was suspected in 35 patients and was definite in 3 patients before CE. After contrast, only 1 patient had a suspected thrombus, and 5 additional patients with thrombus were identified (p < 0.0001). A significant impact of CE on management was observed: additional diagnostic procedures were avoided in 32.8% of patients and drug management was altered in 10.4%, with a total impact (procedures avoided, change in drugs, or both) observed in 35.6% of patients. The impact of contrast increased with worsening quality of nonenhanced study, the highest being in intensive care units. A cost–benefit analysis showed a significant savings using contrast ($122/patient).
Conclusions: The utilization of CE in technically difficult cases improves endocardial visualization and impacts cardiac diagnosis, resource utilization, and patient management.
Key Words: contrast echocardiography • impact • outcome • cost–benefit • transesophageal echocardiography
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Abbreviations and Acronyms
| | CE = contrast echocardiography | | ICU = intensive care unit | | LV = left ventricle/ventricular | | LVEF = left ventricular ejection fraction | | MICU = medical intensive care unit | | SICU = surgical intensive care unit | | TEE = transesophageal echocardiogram/echocardiography |
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