JACC: Inexpensive contrast echo improves patient management, cuts costs
The utilization of contrast echocardiography (CE) in technically difficult cases improves endocardial visualization and impacts cardiac diagnosis, resource utilization 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 technically difficult echocardiographic studies, who received intravenous contrast (Definity; Lantheus Medical Imaging; Billerica, Mass.). They compared quality of studies, number of left ventricular (LV) segments visualized, estimated ejection fraction, presence of apical thrombus and management decisions before and after contrast.

After CE, the researchers found that percent of uninterpretable studies decreased from 11.7 to 0.3 percent and technically difficult studies decreased from 86.7 to 9.8 percent. Before contrast, 11.6 of 17 LV segments were seen, which improved after CE to 16.8. An LV thrombus was suspected in 35 patients and was definite in three patients before CE. After contrast, only one patient had a suspected thrombus and five additional patients with thrombus were identified.

A significant impact of CE on management was observed: additional diagnostic procedures were avoided in 32.8 percent of patients and drug management was 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. The impact of contrast increased with worsening quality of nonenhanced study, the highest being in intensive care units.

A cost-benefit analysis showed a significant savings using contrast--$122 per patient. Patients who are difficult to image with echocardiography are often 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 and costs. Thus, in these technically difficult to image patients, a rapid, simple, inexpensive, and safe test that results in accurate information is desirable," the authors wrote.

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