Key result
IV contrast echocardiography linked to ~80% fewer uninterpretable wall motion segments versus standard echo.
Why the study?
Does intravenous contrast echocardiography improve the interpretability of left ventricular wall motion and ejection fraction compared to standard and harmonic echocardiography in ICU patients?
Observational (n=70)
Does intravenous contrast echocardiography improve the interpretability of left ventricular wall motion and ejection fraction compared to standard and harmonic echocardiography in ICU patients?
Intravenous contrast echocardiography significantly reduces the number of uninterpretable wall motion segments and improves confidence in ejection fraction assessment in ICU patients with suboptimal standard echocardiograms.
May enhance LV wall motion assessment in ICU patients with poor windows; hypothesis-generating and should not yet change practice.
OBJECTIVES: The study examined the value of contrast echocardiography in the assessment of left ventricular (LV) wall motion in intensive care unit (ICU) patients. BACKGROUND: Echocardiograms done in the ICU are often suboptimal. The most common indication is the evaluation of LV wall motion and ejection fraction (EF). METHODS: Transthoracic echocardiograms were done in 70 unselected ICU patients. Wall motion was evaluated on standard echocardiography (SE), harmonic echocardiography (HE), and after intravenous (IV) contrast echocardiography (CE) using a score for each of 16 segments. A confidence score was also given for each segment with each technique (unable to judge; not sure; sure). The EF was estimated visually for each technique, and a confidence score was applied to the EF. RESULTS: Uninterpretable wall motion was present in 5.4 segments/patient on SE, 4.4 on HE (p = 0.2), and 1.1 on CE (p < 0.0001). An average of 7.8 segments were read with surety on SE, 9.2 on HE (p = 0.1), and 13.7 on CE (p < 0.0001). Ejection fraction was uninterpretable in 23% on SE, 13% on HE (p = 0.14), and 0% on CE (p = 0.002 vs. HE; p < 0.0001 vs. SE). The EF was read with surety in 56% of patients on SE, 62% on HE (p = 0.47), and 91% on CE (p < 0.0001). Thus, wall motion was seen with more confidence on CE. More importantly, the actual readings of segmental wall motion and EF significantly differed using CE. CONCLUSIONS: CE should be used in all ICU patients with suboptimal transthoracic echocardiograms.
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Reilly et al. (2000) conducted an observational in Intensive care unit (ICU) patients (n=70). Intravenous contrast echocardiography vs. Standard echocardiography and harmonic echocardiography was evaluated on Uninterpretable wall motion segments per patient (p=<0.0001). Intravenous contrast echocardiography significantly reduced uninterpretable wall motion segments per patient compared to standard echocardiography (1.1 vs 5.4 segments; p<0.0001).
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