Case
Studies
Read About Real-World Experiences
With DEFINITY® in Multiple Care Settings
CASE STUDY: DEFINITY® IN THE CRITICAL CARE UNIT
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
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
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
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
Unenhanced
See in High DEF(INITY)™
DEF(INITY)™
Apical 2-chamber
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.
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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
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
Unenhanced
See in High DEF(INITY)™
Apical 2-chamber
Unenhanced
See in High DEF(INITY)™
Apical Long Axis
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)™
LAD=left anterior descending; PDA=posterior descending artery; PLV=posterolateral vessel; RCA=right coronary artery.
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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
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
Unenhanced
See in High DEF(INITY)™
Apical 2-chamber
Unenhanced
See in High DEF(INITY)™
Apical Long Axis
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
Unenhanced
See in High DEF(INITY)™
Apical 2-chamber
Unenhanced
See in High DEF(INITY)™
Parasternal Long
Unenhanced
See in High DEF(INITY)™
Parasternal Short
Unenhanced
See in High DEF(INITY)™
Apical Long Axis
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:
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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.
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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.