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
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
Establish quality assessment and improvement programs4
training and credentialing4
Ask about the IMPROVE program.
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.