DEFINITY® News and Updates

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DEFINITY® News and Updates

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Case 
Studies

Explore Practical Applications for DEFINITY® Across Multiple Care Settings

Example of DEFINITY® used in critical care with an image representing a 52-year-old man with diabetes and a history of drug abuse experiencing altered mental status
Case study of DEFINITY® in the emergent care setting with an image representing a 39-year-old male patient with chest pain
Example of DEFINITY® used in an inpatient setting with an image representing an 84-year-old-woman with congestive heart failure
Case study of DEFINITY® used in an outpatient setting with an image representing of a 46-year-old woman with hypertrophic cardiomyopathy

Hypothetical patient cases.

Case Study: DEFINITY® in the Critical Care Unit

Example of DEFINITY® used in critical care with an image representing a 52-year-old man with diabetes and a history of drug abuse experiencing altered mental status

52-year-old man

Patient with diabetes mellitus and a history of drug abuse presented with altered mental status, nausea, and vomiting. He complained of chest discomfort for a few days and was found to have evolving anterior ST-segment changes on an electrocardiogram.

Cardiac enzyme testing showed a normal troponin T level and a slightly elevated CK-MB index suggestive of a recent myocardial infarction.

Case Study: DEFINITY® in the Emergent Care Setting

Case study of DEFINITY® in the emergent care setting with an image representing a 39-year-old male patient with chest pain

39-year-old man

Patient presented to the emergency department with chest pain. An electrocardiogram demonstrated an anterior and anterolateral ST-segment depression.

IV nitroglycerin and heparin were initiated, which significantly improved his pain and resolved the ST-segment.

Case Study: DEFINITY® in the Inpatient Setting

Example of DEFINITY® used in an inpatient setting with an image representing an 84-year-old-woman with congestive heart failure

84-year-old woman

Patient was admitted to the hospital for congestive heart failure. She presented with chest and abdominal pain, progressive dyspnea, and nausea for 3 days.

Case Study: DEFINITY® in the Outpatient Setting

Case study of DEFINITY® used in an outpatient setting with an image representing of a 46-year-old woman with hypertrophic cardiomyopathy

46-year-old woman

46-year-old woman with a history of hypertrophic cardiomyopathy, with poor cardiology follow-up. Presented with progressively worsening symptoms of congestive heart failure: dyspnea, lower extremity edema, palpitations.

An echocardiogram was performed to evaluate left ventricular wall motion, status post an acute myocardial infarction
Apical 4-chamber
See in High DEF(INITY)® DEF(INITY)®
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Unenhanced

Enhanced with DEFINITY®

Apical 2-chamber
DEFINITY®
Unenhanced

Unenhanced Echo

  • Hypokinetic left ventricular segments with suspected thrombus in the apex with a high concern for embolic risk

DEFINITY® Echo

  • Hypokinetic left ventricular segments with severely decreased systolic function
  • A large, bulbous, solid, partially fixed thrombus in the apex of the scarred, thinned, and akinetic left ventricle was identified
  • A well-defined space was confirmed by the microbubbles separating a large area of thrombus from the apex, revealing a very high risk of embolism
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CK-MB=creatine kinase muscle and brain; MRI=magnetic resonance imaging.

An echocardiogram was performed to evaluate left ventricular wall motion, status post an acute myocardial infarction

Conclusion

  • The patient was started on systemic anticoagulation with intravenous heparin and medical therapy was initiated for congestive heart failure
  • Neurologic symptoms with the presence of a left ventricular thrombus confirmed the need for a brain MRI for assessment of stroke
  • Cardiomyopathy confirmed the need for ischemic evaluation
  • Surgical consultation was initiated for possible thrombolytic therapy vs surgical embolectomy

DEFINITY® in the critically ill enhanced overall efficiency, diagnostic accuracy, and cost-effective patient management1

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CK-MB=creatine kinase muscle and brain; MRI=magnetic resonance imaging.

An echocardiogram was performed STAT for assessment of acute chest pain
Apical 4-chamber
DEFINITY®
Unenhanced

Unenhanced

Enhanced with DEFINITY®

Apical 2-chamber
DEFINITY®
Unenhanced

Unenhanced

Enhanced with DEFINITY®

Apical Long Axis
DEFINITY®
Unenhanced

Unenhanced Echo

  • Questionable wall motion abnormality in the inferolateral segment

DEFINITY® Echo

  • Mid anterolateral, apical lateral, and anterior wall motion abnormalities identified
  • Mid-to-distal inferolateral wall motion confirmed
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IV=intravenous; LAD=left anterior descending; PDA=posterior descending artery; PLV=posterolateral vessel; RCA=right coronary artery.

An echocardiogram was performed STAT for assessment of acute chest pain

Conclusion

  • Proceeded with an invasive angiogram
  • With DEFINITY®, a timely and critical diagnosis was made, providing the confidence that an invasive procedure was necessary and avoiding further testing and delay of treatment

Cardiac catheterization

  • Significant 2-vessel coronary artery disease with 50% proximal stenosis of the LAD, 80% to 90% mid-vessel stenosis of the RCA, followed by 99% stenosis involving the bifurcation of the PDA and PLV

DEFINITY® in the emergent care setting delivered a diagnostic advantage for improved patient management1

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IV=intravenous; LAD=left anterior descending; PDA=posterior descending artery; PLV=posterolateral vessel; RCA=right coronary artery.

An echocardiogram was performed to assess left ventricular function and to identify the source of the chest pain
Apical 4-chamber
DEFINITY®
Unenhanced

Unenhanced

Enhanced with DEFINITY®

Apical 2-chamber
DEFINITY®
Unenhanced

Unenhanced

Enhanced with DEFINITY®

Apical Long Axis
DEFINITY®
Unenhanced

Unenhanced Echo

  • Unusual echogenic area within the apex, protruding into the left ventricle
  • Ill-determined true nature of an apical abnormality

DEFINITY® Echo

  • Left ventricular opacification with DEFINITY® demonstrated a positive fill of microbubbles within the large space of the occupying lesion, confirming the presence of a mass and ruling out the likelihood of a thrombus
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An echocardiogram was performed to assess left ventricular function and to identify the source of the chest pain

Conclusion

  • Metastatic cardiac tumor identified
  • Started on anticoagulation and rivaroxaban
  • Further diagnostic testing was avoided, allowing for an immediate referral to oncology

DEFINITY® allows bedside cardiac assessment and timely diagnosis for cost-effective patient management in hospitalized patients2

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An echocardiogram was performed for congestive heart failure
Apical 4-chamber
DEFINITY®
Unenhanced

Unenhanced

Enhanced with DEFINITY®

Apical 2-chamber
DEFINITY®
Unenhanced

Unenhanced

Enhanced with DEFINITY®

Parasternal Long
DEFINITY®
Unenhanced

Unenhanced

Enhanced with DEFINITY®

Parasternal Short
DEFINITY®
Unenhanced

Unenhanced

Enhanced with DEFINITY®

Apical Long Axis
DEFINITY®
Unenhanced

Unenhanced Echo

  • Prominent left ventricular hypertrophy with hyperdynamic left ventricular function
  • Asymmetric basal septal hypertrophy with systolic anterior motion of the anterior mitral valve leaflet and small pericardial effusion

DEFINITY® Echo

  • Prominent septal left ventricular hypertrophy with hyperdynamic left ventricular function
  • Normal lateral wall thickness compared to the unenhanced image
  • Prominent basal septal hypertrophy is evident in the parasternal long axis view
  • Short axis sweep reveals the geometry of hypertrophic cardiomyopathy, demonstrating a counterclockwise rotation from the basal anterior wall to the distal inferoapical segment
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An echocardiogram was performed for congestive heart failure

Conclusion

  • Rare variant of spiral hypertrophic cardiomyopathy identified
  • The patient was started on guideline-directed medical therapy to decrease left ventricular contractility and the outflow tract gradient
  • An implantable cardioverter-defibrillator was placed due to risk for sudden cardiac death

DEFINITY® helped identify a rare variant of spiral hypertrophic cardiomyopathy

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References:

  1. 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.

  2. 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.

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:

  1. 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
  2. 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. doi:10.1016/j.jacc.2009.01.005

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