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Diagnostic
Challenges


The Challenges of Nondiagnostic Echos
Even with advancements in echocardiography, imaging can be suboptimal, which may lead to1-4:
- Inadequate treatment plans
- Unnecessary additional testing
- Increased hospital stays
- Avoidable hospital admissions
Apical hypertrophic cardiomyopathy
Unenhanced
DEFINITY®
How to Obtain Diagnostic Echos
Implementing the American Society of Echocardiography (ASE) guidelines for ultrasound enhancing agents can help improve efficiency and patient care.5
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 ECG
- When LV thrombus cannot be ruled in or out
- When structural abnormalities, such as noncompaction cardiomyopathy, apical hypertrophy, and aneurysms, cannot be adequately assessed
- For diagnosis and exclusion of pseudoaneurysms

Create written policies for using ultrasound enhancing
agents3

Establish quality assessment and improvement programs2

Maintain personnel
training and credentialing2,3
ECG=electrocardiogram; ED=emergency department; ICU=intensive care unit; LV=left ventricular; LVEF=left ventricular ejection fraction; UEA=ultrasound enhancing agent.
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.
INDICATION
DEFINITY® is indicated, after activation, for use in adult and pediatric patients with suboptimal echocardiograms to opacify the left ventricular chamber and to improve the delineation of the left ventricular endocardial border.
IMPORTANT SAFETY INFORMATION
BOXED WARNING: SERIOUS CARDIOPULMONARY REACTIONS
Serious cardiopulmonary reactions, including fatalities, have occurred uncommonly during or following perflutren-containing microsphere administration. Most serious reactions occur within 30 minutes of administration.
- Assess all patients for the presence of any condition that precludes DEFINITY® administration.
- Always have resuscitation equipment and trained personnel readily available.
References:
- Lindner JR. A practical approach to contrast echocardiography. American College of Cardiology. July 10, 2017. Accessed March 18, 2021. https://www.acc.org/latest-in-cardiology/articles/2017/07/10/09/17/a-practical-approach-to-contrast-echocardiography
- Picard MH, Adams D, Bierig SM, et al. American Society of Echocardiography recommendations for quality echocardiography laboratory operations. J Am Soc Echocardiogr. 2011;24(1):1-10. doi:10.1016/j.echo.2010.11.006
- 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. doi:10.1016/j.echo.2017.11.013
- Main ML, Fu JW, Gundrum J, LaPointe NA, Gillam LD, Mulvagh SL. Impact of contrast echocardiography on outcomes in critically ill patients. Am J Cardiol. 2021;150:117-122. doi:10.1016/j.amjcard.2021.03.039
- Mulvagh SL, Rakowski H, Vannan MA, et al. American Society of Echocardiography consensus statement on the clinical applications of ultrasonic contrast agents in echocardiography. J Am Soc Echocardiogr. 2008;21(11):1179-1281. doi:10.1016/j.echo.2008.09.009
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