Contrast-enhanced echocardiography significantly increased the detected wall motion score index compared to greyscale analysis (1.29 vs 1.23, p<0.003) in patients without standard indications.
Observational (n=192)
Blinded to previous results for repeated analyses
No
Does contrast-enhanced echocardiography improve the detection of wall motion and structural abnormalities compared to greyscale echocardiography in patients without standard indications for contrast?
The use of contrast-enhanced echocardiography beyond current guideline recommendations may significantly improve the detection of subtle wall motion and structural abnormalities while reducing inter-reader variability.
Absolute Event Rate: 1.29% vs 1.23%
p-value: p=<0.003
BACKGROUND: Contrast agents are used in resting echocardiography to opacify the left ventricular (LV) cavity and to improve LV endocardial border delineation in patients with suboptimal image quality. If a wider use of contrast-enhanced echocardiography would be adopted instead of the current selective approach, diagnoses such as myocardial ischemia and LV structural abnormalities could potentially be detected earlier. The aim was therefore to retrospectively investigate if contrast-enhanced echocardiography beyond the current recommendations for contrast agent usage affects assessment of wall motion abnormalities, ejection fraction (EF) and detection of LV structural abnormalities. A secondary aim was to evaluate the user dependency during image analysis. METHODS: Experienced readers (n = 4) evaluated wall motion score index (WMSI) and measured EF on greyscale and contrast-enhanced images from 192 patients without indications for contrast-enhanced echocardiography. Additionally, screening for LV structural abnormalities was performed. Repeated measurements were performed in 20 patients by the experienced as well as by inexperienced (n = 2) readers. RESULTS: Contrast analysis resulted in significantly higher WMSI compared to greyscale analysis (p < 0.003). Of the 83 patients, classified as healthy by greyscale analysis, 55% were re-classified with motion abnormalities by contrast analysis. No significant difference in EF classification (≥55%, 45-54%, 30-44%, < 30%) was observed. LV structural abnormalities, such as increased trabeculation (n = 21), apical aneurysm (n = 4), hypertrophy (n = 1) and thrombus (n = 1) were detected during contrast analysis. Intra- and interobserver variability for experienced readers as well as the variability between inexperienced and experienced readers decreased for WMSI and EF after contrast analysis. CONCLUSIONS: Contrast-enhanced echocardiography beyond current recommendations for contrast agent usage increased the number of detected wall motion and LV structural abnormalities. Moreover, contrast-enhanced echocardiography increased reproducibility for assessment of WMSI and EF.
Larsson et al. (Tue,) conducted a observational in Patients referred for stress echocardiography without standard indications for contrast (n=192). Contrast-enhanced echocardiography vs. Greyscale echocardiography was evaluated on Wall motion score index (WMSI) (p=<0.003). Contrast-enhanced echocardiography significantly increased the detected wall motion score index compared to greyscale analysis (1.29 vs 1.23, p<0.003) in patients without standard indications.
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