This Article Figures Only Full Text Full Text (PDF) View Related Cardiosource Journal Scan All Versions of this Article: j.jacc.2009.01.005v1 53/9/802    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kurt, M. Articles by Zoghbi, W. A. Search for Related Content PubMed PubMed Citation Articles by Kurt, M. Articles by Zoghbi, W. A.

EXPEDITED PUBLICATION

Impact of Contrast Echocardiography on Evaluation of Ventricular Function and Clinical Management in a Large Prospective Cohort

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. 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

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

This article has been cited by other articles:

				S. Kutty, J. Olson, C. J. Danford, E. K. Sandene, F. Xie, S. E. Fletcher, C. C. Erickson, J. D. Kugler, D. A. Danford, and T. R. Porter Ultrasound contrast and real-time perfusion in conjunction with supine bicycle stress echocardiography for comprehensive evaluation of surgically corrected congenital heart disease Eur Heart J Cardiovasc Imaging, December 15, 2011; (2011) jer287v1. [Abstract] [Full Text] [PDF]

				F. Puskas, J. C. Cleveland Jr, R. Singh, N. S. Weitzel, T. B. Reece, R. Shull, E. E. Salcedo, and T. Seres Detection of Left Ventricular Apical Thrombus With Three-Dimensional Transesophageal Echocardiography Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2011; 15(3): 102 - 104. [Abstract] [PDF]

				J. W. Weinsaft, H. W. Kim, A. L. Crowley, I. Klem, C. Shenoy, L. Van Assche, R. Brosnan, D. J. Shah, E. J. Velazquez, M. Parker, et al. LV Thrombus Detection by Routine Echocardiography: Insights Into Performance Characteristics Using Delayed Enhancement CMR J. Am. Coll. Cardiol. Img., July 1, 2011; 4(7): 702 - 712. [Abstract] [Full Text] [PDF]

				L. H. Eraso, M. P. Reilly, C. Sehgal, and E. R. Mohler Emerging diagnostic and therapeutic molecular imaging applications in vascular disease Vascular Medicine, April 1, 2011; 16(2): 145 - 156. [Abstract] [PDF]

				L. Galiuto, R. Senior, and H. Becher Chapter 7 Contrast echocardiography The EAE Textbook of Echocardiography, March 1, 2011; 1(1): med-9780199599639-chapter - med-9780199599639-chapter. [Abstract] [Full Text]

				F. A. Flachskampf, M. Schmid, C. Rost, S. Achenbach, A. N. DeMaria, and W. G. Daniel Cardiac imaging after myocardial infarction Eur. Heart J., February 1, 2011; 32(3): 272 - 283. [Abstract] [Full Text] [PDF]

				A. E. Weyman The Year in Echocardiography J. Am. Coll. Cardiol., December 7, 2010; 56(24): 2033 - 2044. [Full Text] [PDF]

				S. Achenbach, C. M. Kramer, W. A. Zoghbi, and V. Dilsizian The Year in Coronary Artery Disease J. Am. Coll. Cardiol. Img., October 1, 2010; 3(10): 1065 - 1077. [Abstract] [Full Text] [PDF]

				M. Pepi, A. Evangelista, P. Nihoyannopoulos, F. A. Flachskampf, G. Athanassopoulos, P. Colonna, G. Habib, E. B. Ringelstein, R. Sicari, J. L. Zamorano, et al. Recommendations for echocardiography use in the diagnosis and management of cardiac sources of embolism: European Association of Echocardiography (EAE) (a registered branch of the ESC) Eur Heart J Cardiovasc Imaging, July 1, 2010; 11(6): 461 - 476. [Abstract] [Full Text] [PDF]

				N. S. Chahal and R. Senior Clinical Applications of Left Ventricular Opacification J. Am. Coll. Cardiol. Img., February 1, 2010; 3(2): 188 - 196. [Abstract] [Full Text] [PDF]

				K. Wei Utility Contrast Echocardiography in the Emergency Department J. Am. Coll. Cardiol. Img., February 1, 2010; 3(2): 197 - 203. [Abstract] [Full Text] [PDF]

				T. H. Marwick and J. Narula Contrast Echocardiography: Over-Achievement in Research, Under-Achievement in Practice? J. Am. Coll. Cardiol. Img., February 1, 2010; 3(2): 224 - 225. [Full Text] [PDF]

				M. L. Main Ultrasound Contrast Agent Safety: From Anecdote to Evidence J. Am. Coll. Cardiol. Img., September 1, 2009; 2(9): 1057 - 1059. [Full Text] [PDF]