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
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Figure 1 Impact of Contrast on Quality of Study
A significant increase in quality of echocardiograms is seen after contrast use across all locations. *p < 0.0001 comparing quality before and after contrast for total and all subgroups. Inpt = inpatient; MICU = medical intensive care unit; SICU = surgical intensive care unit.
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Figure 2 Impact of Contrast on Segments Visualized Per Patient
After contrast, a significant increase in visualization of total number of segments and of abnormal segments was observed. *p < 0.0001 comparing number of segments visualized before and after contrast.  p = 0.0016 comparing number of segments visualized before and after contrast. CE = contrast echocardiography; other abbreviations as in Figure 1.
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Figure 3 Impact of Contrast on Left Ventricular EF Assessment
After contrast, a significant decrease in the number of uninterpretable studies was seen, with overall higher left ventricular ejection fraction (EF).
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Figure 4 Impact of Contrast on Additional Planned Diagnostic Procedures
The use of contrast avoided further planned diagnostic procedures, the highest observed in the SICU setting. *p < 0.0001 comparing SICU with inpatients. p < 0.0001 comparing SICU with outpatients. TEE = transesophageal echocardiogram; other abbreviations as in Figure 1.
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Figure 5 Impact of Contrast on Medication Changes
Frequency of changes in hemodynamic drugs and anticoagulation observed by patient location. *p < 0.0001 comparing SICU with inpatients. p < 0.0001 comparing SICU with MICU. Abbreviations as in Figure 1.
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Figure 6 Total Impact of Contrast on Patient Management
Frequency of total impact of contrast use on patient management. The highest impact was observed in inpatients, particularly in the SICU. *p < 0.0001 comparing SICU with inpatient ward. p < 0.0001 comparing SICU with outpatients.  p = 0.0004 comparing SICU and MICU. Abbreviations as in Figure 1.
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Figure 7 Relation of Extent of Nonvisualized Left Ventricular Segments to Impact of Contrast on Management
The higher the number of segments that could not be visualized, the higher was the impact of contrast echocardiography on management.
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