Diagnostic
Challenges

The Challenges of Nondiagnostic Echoes

Even with advancements in echocardiography, imaging can be suboptimal,¹ which may lead to²:

Inadequate treatment plans
Unnecessary additional testing
Increased hospital stays
Avoidable hospital readmissions

Apical hypertrophic cardiomyopathy

Unenhanced

DEFINITY®⁷

How to Obtain Diagnostic Echoes

Implementing the American Society of Echocardiography (ASE) guidelines for ultrasound enhancing agents can help improve efficiency and patient care.³

A Summary from the ASE UEA Guidelines³:

When 2 or more LV segments cannot be visualized
In all patients for whom quantitative assessment of LVEF is important
For all technically difficult ICU and ED patients for quick and accurate diagnosis and to reduce additional diagnostic testing
In ED patients presenting with myocardial ischemia and nondiagnostic EKG

When LV thrombus cannot be ruled in or out
When structural abnormalities cannot be adequately assessed, such as noncompaction, apical hypertrophy, aneurysms
For diagnosis and exclusion of pseudoaneurysms

Create written policies for using ultrasound enhancing
agents⁴

Establish quality assessment and improvement programs⁴

Maintain personnel
training and credentialing⁴

Order DEFINITY® products

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Know your suboptimal echo rate. Ask about the IMPROVE program.

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References:

Lindner JR. A practical approach to contrast echocardiography. American College of Cardiology. Published July 10, 2017. Accessed May 27, 2021. https://www.acc.org/latest-in-cardiology/articles/2017/07/10/09/17/a-practical-approach-to-contrast-echocardiography
Kurt M, Shaikh KA, Peterson L, et al. Impact of contrast echocardiography on evaluation of ventricular function and clinical management in a large prospective cohort. J Am Coll Cardiol. 2009;53(9):802-810.
Porter TR, Mulvagh SL, Abdelmoneim SS, et al. Clinical applications of ultrasonic enhancing agents in echocardiography: 2018 american society of echocardiography guidelines update. J Am Soc Echocardiogr. 2018:31(3):241-274.
Porter TR, Abdelmoneim S, Belcik JT, et al. Guidelines for the cardiac sonographer in the performance of contrast echocardiography: a focused update from the American Society of Echocardiography. J Am Soc Echocardiogr. 2014;27(8):797-810.

DEFINITY® RT (Perflutren Lipid Microsphere) Injectable Suspension

INDICATIONS

Activated DEFINITY® and activated DEFINITY® RT (Perflutren Lipid Microsphere) Injectable Suspension are indicated for use in patients with suboptimal echocardiograms to opacify the left ventricular chamber and to improve the delineation of the left ventricular endocardial border.

CONTRAINDICATIONS

Do not administer DEFINITY® and DEFINITY® RT to patients with known or suspected hypersensitivity to perflutren lipid microsphere or its components, such as polyethylene glycol (PEG).

IMPORTANT SAFETY INFORMATION

WARNING: SERIOUS CARDIOPULMONARY REACTIONS

Serious cardiopulmonary reactions, including fatalities, have occurred uncommonly during or following perflutren-containing microsphere administration [see Warnings and Precautions (5.1)]. Most serious reactions occur within 30 minutes of administration.

Assess all patients for the presence of any condition that precludes DEFINITY® and DEFINITY® RT administration [see Contraindications (4)].
Always have resuscitation equipment and trained personnel readily available.

In postmarketing use, rare but serious cardiopulmonary or hypersensitivity reactions have been reported during or shortly following perflutren and PEG-containing microsphere administration [see Adverse Reactions (6)]. The risk for these reactions may be increased among patients with unstable cardiopulmonary conditions and/or with pre-existing PEG hypersensitivity [see Adverse Reactions (6.2)]. It is not always possible to reliably establish a causal relationship to drug exposure due to the presence of underlying conditions.

Patients with sickle cell disease may be at higher risk of painful crisis and DEFINITY® and DEFINITY® RT should be administered with caution.

Please see accompanying full Prescribing Information, including boxed WARNING regarding serious cardiopulmonary reactions.

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Diagnostic Challenges

The Challenges of Nondiagnostic Echoes

How to Obtain Diagnostic Echoes

Diagnostic
Challenges