JACC: Inexpensive contrast echo improves patient management, cuts costs

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The utilization of contrast echocardiography (CE) in technically difficult cases improvesendocardial visualization and impacts cardiac diagnosis, resourceutilization and patient management, according to a study published online Feb. 11 in the Journal of the American College of Cardiology.

Mustafa Kurt, MD, and colleagues from the department of cardiology at the Methodist Hospital, and the Methodist DeBakey Heart and Vascular Center Imaging Institute in Houston, prospectively enrolled 632 consecutive patients with technicallydifficult echocardiographic studies, who received intravenouscontrast (Definity; Lantheus Medical Imaging; Billerica, Mass.). They comparedquality of studies, number of left ventricular (LV) segmentsvisualized, estimated ejection fraction, presence of apicalthrombus and management decisions before andafter contrast.

After CE, the researchers found that percent of uninterpretable studies decreased from11.7 to 0.3 percent and technically difficult studies decreased from86.7 to 9.8 percent. Before contrast, 11.6 of 17 LV segments were seen, which improved after CE to16.8. An LV thrombus was suspectedin 35 patients and was definite in three patients before CE. Aftercontrast, only one patient had a suspected thrombus and five additionalpatients with thrombus were identified.

A significantimpact of CE on management was observed: additional diagnosticprocedures were avoided in 32.8 percent of patients and drug managementwas altered in 10.4 percent, with a total impact (procedures avoided,change in drugs, or both) observed in 35.6 percent of patients, according to the investigators. Theimpact of contrast increased with worsening quality of nonenhancedstudy, the highest being in intensive care units.

A cost-benefitanalysis showed a significant savings using contrast--$122 per patient. Patients who are difficult to image with echocardiography areoften referred for additional testing to obtain accurate information, according to reasearchers.

"Although these modalities can provide accurate information,they may be associated with additional risks, time delays andcosts. Thus, in these technically difficult to image patients,a rapid, simple, inexpensive, and safe test that results inaccurate information is desirable," the authors wrote.

Kurt and colleagues also reported that the impact ofcontrast on patient management was inversely related to thequality of the baseline study. The greatest degree of improvementin evaluation of LV ejection fraction and regional function was seen in theICU population, especially in the surgical ICU. The same group alsohad the highest impact of CE on management (62.7 percent).