Efficacy and time-efficiency of a “sonographer-driven” contrast echocardiography protocol in a high-volume echocardiography laboratory

Castelló, Ramón; Bella, Jonathan N.; Rovner, Aleksandr; Swan, Jimmy; Smith, J. Chandler; Shaw, Leslie J.

doi:10.1067/mhj.2003.164

Cited by 30 publications

(19 citation statements)

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“…12,13 While prior studies have reported that echo contrast improves LV thrombus detection, use has almost always been reserved for selected patients with suboptimal non-contrast echo quality. 4,14 Our results demonstrate that while echo contrast improved image quality in the overall population, image quality alone did not predict improved thrombus assessment. For example, among patients with thrombus by DE-CMR, image quality scores did not differ between non-contrast echoes that detected thrombus and those in which in which contrast use provided additive benefit.…”

Section: Discussionmentioning

confidence: 62%

Contrast-Enhanced Anatomic Imaging as Compared to Contrast-Enhanced Tissue Characterization for Detection of Left Ventricular Thrombus

Weinsaft

Kim

Ross

et al. 2009

JACC: Cardiovascular Imaging

186

166

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Objectives To compare contrast-enhanced anatomic imaging to contrast-enhanced tissue characterization (DE-CMR) for left ventricular (LV) thrombus detection. Background Contrast echocardiography (echo) detects LV thrombus based on anatomic appearance whereas delayed-enhancement cardiac magnetic resonance (DE-CMR) imaging detects thrombus based on tissue characteristics. DE-CMR has been validated as an accurate technique for thrombus but its utility compared to contrast echo is unknown. Methods Multimodality imaging was performed in 121 patients at high-risk for thrombus due to myocardial infarction or heart failure. Imaging included three anatomic imaging techniques for thrombus detection (contrast echo, non-contrast echo, cine-CMR) and a reference of DE-CMR tissue characterization. LV structural parameters were quantified to identify markers for thrombus and predictors of additive utility of contrast-enhanced thrombus imaging. Results 24 patients had thrombus by DE-CMR. Patients with thrombus had larger infarcts (by DE-CMR), more aneurysms and lower LVEF (by CMR and echo) than those without thrombus. Contrast echo nearly doubled sensitivity (61% vs. 33%, p<0.05) and yielded improved accuracy (92% vs. 82%, p<0.01) vs. non-contrast echo. Patients who derived incremental diagnostic utility from DE-CMR had lower LVEF vs. those in whom non-contrast echo alone accurately assessed thrombus (35±9% vs. 42±14%, p<0.01), with a similar trend for patients that derived incremental benefit from contrast echo (p=0.08). Contrast echo and cine-CMR closely agreed on the diagnosis of thrombus (kappa=0.79, p<0.001). Thrombus prevalence was lower by contrast echo than DE-CMR (p<0.05). Thrombus detected by DE-CMR but not by contrast echo was more likely to be mural in shape or, when apical, small in volume (p<0.05). Conclusions Echo contrast in high-risk patients markedly improves detection of LV thrombus, but does not detect a substantial number of thrombi identified by DE-CMR tissue characterization. Thrombi detected by DE-CMR but not by contrast echo are typically mural in shape or small in volume.

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Section: Discussionmentioning

confidence: 62%

Contrast-Enhanced Anatomic Imaging as Compared to Contrast-Enhanced Tissue Characterization for Detection of Left Ventricular Thrombus

Weinsaft

Kim

Ross

et al. 2009

JACC: Cardiovascular Imaging

186

166

View full text Add to dashboard Cite

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“…A move towards setting obligatory policies by accreditation agencies for contrast use when image quality is poor together with a mandate that sonographers applying for individual accreditation perform at an agreed number of contrastenhanced scans will help to empower the sonographer to change his/her approach towards the difficult-toscan patient. There are also concerns that contrast studies are time consuming; however, "sonographerdriven" contrast echocardiography has been shown to reduce the total time required to perform a contrastenhanced study to less than the time required to perform an unenhanced, technically difficult study (34). An accredited echo laboratory should have a designated sonographer or nurse who has been appropriately trained to perform intravenous cannulation and administer contrast agents, thereby alleviating the dependency of the laboratory on the availability of a physician to perform the test.…”

Section: The Ambivalence Towards Contrast Agentsmentioning

confidence: 98%

Clinical Applications of Left Ventricular Opacification

Chahal

Senior

2010

JACC: Cardiovascular Imaging

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The significant advances made in ultrasound microbubble technology now permits reliable, reproducible left ventricular opacification, and this review reiterates the evidence that has shown contrast echocardiography to be clinically effective, to reduce downstream costs and to spare patients further, potentially hazardous investigations. Despite the evidence and the advances, there remains ambivalence towards the administration of contrast agents in echocardiography laboratories throughout the world, particularly in the performance of rest studies. Therefore, this review also addresses some of the reasons for the suboptimal uptake of contrast agents and encourages physicians, sonographers, and accreditatory bodies to adopt a different approach towards the difficult-to-image patient.

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“…Nonetheless, an adequate transthoracic window can usually be obtained. Echocontrast improves the identification of endocardial borders and assessment of ventricular wall motion [14], and increases the number of segments available for evaluation of wall thickening in all four views with the biggest gains in the apical views [15].…”

Section: Echocardiographymentioning

confidence: 99%

Challenges in Cardiac Risk Assessment in Bariatric Surgery Patients

et al. 2007

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Bariatric surgery has serious associated medical comorbidity and procedure-related risks and is thus considered an intermediate- to high-risk noncardiac surgery. Most patients referred for bariatric surgery have a low or very low functional capacity, making cardiac risk assessment imperative. Stress echocardiography has a high negative predictive value and can avoid some of the table weight and torso diameter problems associated with myocardial perfusion imaging. Echocardiograph contrast agents improve the ability to identify endocardial borders and assess ventricular wall motion and may be used with stress and nonstress imaging protocols. Single photon emission computer tomography (SPECT) imaging with attenuation correction, combined supine and prone imaging, use of technetium isotope, and positron emission tomography (PET) imaging may all provide some advantage for myocardial perfusion imaging for the obese patient.

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Efficacy and time-efficiency of a “sonographer-driven” contrast echocardiography protocol in a high-volume echocardiography laboratory

Cited by 30 publications

References 0 publications

Contrast-Enhanced Anatomic Imaging as Compared to Contrast-Enhanced Tissue Characterization for Detection of Left Ventricular Thrombus

Contrast-Enhanced Anatomic Imaging as Compared to Contrast-Enhanced Tissue Characterization for Detection of Left Ventricular Thrombus

Clinical Applications of Left Ventricular Opacification

Challenges in Cardiac Risk Assessment in Bariatric Surgery Patients

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