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

This study was presented in part at the 57th Annual Scientific Sessions of the American College of Cardiology, March 31, 2008, Chicago, Illinois.
https://doi.org/10.1016/j.jacc.2009.01.005Get rights and content
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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

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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