Korean Circ J.  2015 Nov;45(6):486-491. 10.4070/kcj.2015.45.6.486.

The Clinical Impact of Bedside Contrast Echocardiography in Intensive Care Settings: A Korean Multicenter Study

• Hwang HJ
• Sohn IS
• Kim WS
• Hong GR
• Choi EY
• Rim SJ
• Lee SC
• Chung WJ
• Choi JH
• Seo HS
• Yoon SJ
• Cho KI
• Kim HS
• Yoon HJ

• KMID: 2223787
• DOI: http://doi.org/10.4070/kcj.2015.45.6.486

Abstract

BACKGROUND AND OBJECTIVES
We assessed the ability of portable echocardiography (with contrasts) to clearly delineate the cardiac structure, and evaluated the impact of its use on the diagnosis and management of critically ill patients in Korea.
SUBJECTS AND METHODS
We prospectively enrolled 123 patients (mean age 66+/-16 years), who underwent portable transthoracic echocardiography (with contrast) for image enhancement at 12 medical centers. The quality of the global left ventricular (LV) images, the number of the regional LV segments visualized, the ability to visualize the LV apex and the right ventricle (RV), and any changes in the diagnostic procedure and treatment strategy were compared before and after the contrast.
RESULTS
Of the 123 patients, 52 (42%) were using mechanical ventilators. The amount of poor or uninterpretable images decreased from 48% to 5% (p<0.001), after the contrast. Before the contrast, 15.6+/-1.1 of 16 LV segments were seen, which improved to 15.9+/-0.6 segments (p=0.001) after the contrast. The ability to visualize the LV apex increased from 47% to 94% (p<0.001), while the inability to clearly visualize the RV decreased from 46% to 19% (p<0.001). Changes in the diagnostic procedure (for example, not requiring other types of imaging studies) were observed in 18% of the patients, and the treatment plan (medication) was altered in 26% of patients after the contrast echocardiography.
CONCLUSION
The use of a contrast agent during the portable echocardiography, in intensive care settings, can improve the image quality and impact the diagnostic procedures and treatment for Korean patients.

Keyword

Echocardiography; Intensive care

MeSH Terms

Critical Illness
Diagnosis
Echocardiography*
Heart Ventricles
Humans
Image Enhancement
Critical Care*
Korea
Prospective Studies
Ventilators, Mechanical

Figure

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  Fig. 1 The effect of contrast echocardiography on the global left ventricular (LV) image quality. Contrast echocardiography significantly improves the general LV image quality, compared to fundamental echocardiography (McNemar's test, p<0.001 comparing uninterpretable and poor with fair and adequate).

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  Fig. 2 The effect of contrast echocardiography on the visualization of the left ventricular (LV) apex. Contrast echocardiography significantly improves the ability to visualize the LV apex, compared to fundamental echocardiography (p<0.001).

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  Fig. 3 The effect of contrast echocardiography on the visualization of the right ventricle (RV). Contrast echocardiography significantly improves the ability to visualize the RV (p<0.001).

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  Fig. 4 A comparison of the estimated ejection fractions, between pre-contrast and post-contrast images (Wilcoxon signed rank test, p=0.106, in incremental ranges of 10%).

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  Fig. 5 The impact of contrast echocardiography on diagnostic procedures. Contrast echocardiography decreased the need for additional diagnostic imaging procedures in 22 patients (18%). TEE: transesophageal echocardiography, CAG: coronary angiography.

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  Fig. 6 The impact of contrast echocardiography on management strategies. Contrast echocardiography altered the management plan for 32 patients (26%).

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