Case
Studies

Read About Real-World Experiences
With DEFINITY® in Multiple Care Settings

Critical care unit patient.
Emergent care setting patient.
Hospital inpatient patient.
Outpatient patient.

CASE STUDY: DEFINITY® IN THE CRITICAL CARE UNIT

Critical care unit patient.

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

Emergent care setting patient.

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

Hospital inpatient patient.

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

Outpatient patient.

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)®
Unenhanced

Unenhanced

See in High DEF(INITY)™*

DEF(INITY)™*

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
See in High DEF(INITY)™

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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 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

DEFINITIONS:
CK-MB=creatine kinase muscle and brain.

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

Unenhanced

See in High DEF(INITY)™*

Apical 2-chamber
DEFINITY®
Unenhanced

Unenhanced

See in High DEF(INITY)™*

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
See in High DEF(INITY)™

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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, avoiding further testing and delay of treatment

Cardiac catheterization

  • Significant 2-vessel coronary artery disease with 50% proximal stenosis of the LAD, 80-90% 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 management1,2

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

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

Unenhanced

See in High DEF(INITY)™*

Apical 2-chamber
DEFINITY®
Unenhanced

Unenhanced

See in High DEF(INITY)™*

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
See in High DEF(INITY)™

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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 patients1

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

Unenhanced

See in High DEF(INITY)™*

Apical 2-chamber
DEFINITY®
Unenhanced

Unenhanced

See in High DEF(INITY)™*

Parasternal Long
DEFINITY®
Unenhanced

Unenhanced

See in High DEF(INITY)™*

Parasternal Short
DEFINITY®
Unenhanced

Unenhanced

See in High DEF(INITY)™*

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 counter-clockwise rotation from the basal anterior wall to the distal inferoapical segment
See in High DEF(INITY)™

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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.