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Publication Date

1-25-2016

Keywords

contrast echocardiography, left ventricular delineation, contrast administration, safety, misuse, examination time, cost-effectiveness

Abstract

Purpose

There is much evidence-based research proving the effectiveness of contrast echocardiography, but there are still questions and concerns about its specific uses. This study tested the effectiveness of contrast echocardiography in defining the left ventricular endocardial border.

Methods

From 30 patients, a total of 60 echocardiograms –– 30 with and 30 without use of contrast –– were retrospectively reviewed by four blinded cardiologists with advanced training in echocardiography. No single cardiologist reviewed contrast and noncontrast images of the same patient. Each set of 30 echocardiograms was then studied for wall-motion scoring. Visualization of left ventricular wall segments and a global visualization confidence level of interpretation were recorded.

Results

Of all wall segments (N = 510), 91% were visualized in echocardiograms with use of contrast, whereas 75% of the walls were visualized in echocardiograms without contrast (P < 0.001). Of 30 examinations, 17 contrast echocardiograms were read with high confidence compared to 6 without contrast use (P = 0.004). The number of walls visualized with contrast was increased in 18 patients (60%), whereas noncontrast echocardiograms yielded more visualized walls in 6 patients (20%, P = 0.002).

Conclusions

This study demonstrates that contrast is valuable to echocardiographic imaging. Its use should be supported throughout echocardiography clinics and encouraged in certain patients for whom resting and stress echocardiography results without contrast often prove uninterpretable.

Online Video 1.avi (6202 kB)
Echocardiography in the parasternal long-axis view without contrast in a sample patient.

Online Video 2.avi (3992 kB)
Echocardiography in the parasternal long-axis view with contrast in the same patient as Online Video 1.

Online Video 3.avi (13495 kB)
Echocardiography in the parasternal short-axis view without contrast in the same patient as Online Video 1.

Online Video 4.avi (5240 kB)
Echocardiography in the parasternal short-axis view with contrast in the same patient as Online Video 1.

Online Video 5.avi (8198 kB)
Echocardiography in the apical four-chamber view without contrast in the same patient as Online Video 1.

Online Video 6.avi (9550 kB)
Echocardiography in the apical four-chamber view with contrast in the same patient as Online Video 1.

Online Video 7.avi (6620 kB)
Echocardiography in the apical two-chamber view without contrast in the same patient as Online Video 1.

Online Video 8.avi (5830 kB)
Echocardiography in the apical two-chamber view with contrast in the same patient as Online Video 1.

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