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Contrast echocardiography is superior to tissue harmonics for assessment of left ventricular function in mechanically
M Kornbluth1, D H Liang, P Brown
1Stanford University, Division of Cardiovascular Medicine, CA 94305-5233, USA.
Insights
Contrast echocardiography significantly improves endocardial border detection and wall motion scoring in mechanically ventilated patients. This advanced imaging technique enhances diagnostic accuracy for left ventricular function assessment.
Area of Science:
- Cardiology
- Medical Imaging
- Critical Care Medicine
Background:
- Echocardiography for assessing left ventricular function is challenging in mechanically ventilated patients.
- Standard fundamental imaging may limit endocardial border detection (EBD).
- Evaluating contrast-enhanced and tissue harmonic imaging is crucial for improving visualization.
Purpose of the Study:
- To assess the value of contrast-enhanced echocardiography and tissue harmonic imaging.
- To compare their efficacy against standard fundamental imaging for EBD in mechanically ventilated patients.
Main Methods:
- Fifty mechanically ventilated patients underwent transthoracic 2D echocardiography.
- Studies were performed using fundamental mode, tissue harmonic imaging, and contrast enhancement (Optison).
- Two echocardiographers evaluated EBD, wall motion scoring, and ejection fraction quantification.
Main Results:
- Contrast echocardiography improved visualization in 68% of segments versus 17% for tissue harmonics.
- Diagnostic studies increased from 15% to 85% with contrast echocardiography.
- Wall motion scoring was possible in 95% of segments with contrast versus 61% with fundamental mode.
Conclusions:
- Contrast echocardiography is superior to tissue harmonic imaging for EBD.
- It also outperforms tissue harmonic imaging in wall motion scoring and ejection fraction quantification.
- Contrast imaging enhances diagnostic capabilities for left ventricular function in mechanically ventilated patients.
Background:
Assessment of left ventricular function by echocardiography is frequently challenging in mechanically ventilated patients. We evaluated the potential value of contrast-enhanced imaging and tissue harmonic imaging over standard fundamental imaging for endocardial border detection (EBD) in these patients.
Methods And Results:
Fifty patients underwent standard transthoracic 2D echocardiography and were imaged in fundamental and tissue harmonic modes and subsequently with intravenous contrast (Optison). Two echocardiographers reviewed all studies for ease of visualization of endocardial border segments and scoring of wall motion. EBD for each wall segment was graded from 1 to 4 (1 = excellent EBD). Wall motion was scored by a standard 16-segment model and 1 to 5 scale. Studies were categorized as nondiagnostic if 4 of 6 segments in the apical 4-chamber view were either poorly seen or not seen (EBD score 3 or 4). Quantification of ejection fraction was independently performed offline. Visualization of 68% of all segments improved with contrast echocardiography versus 17% improvement with tissue harmonics compared with fundamental mode. Significant improvement (poor/not seen to good/excellent) occurred in 60% of segments with contrast echocardiography versus 18% with tissue harmonics. A total of 850 segments were deemed poor/not seen, 78% of which improved to good/excellent with contrast echocardiography versus 23% with tissue harmonics. Interobserver agreement on EBD was 64% to 70%. Conversion of nondiagnostic to diagnostic studies occurred in 85% of patients with contrast echocardiography versus 15% of patients with tissue harmonics. Scoring of wall motion with fundamental mode, tissue harmonics, and contrast echocardiography was possible in 61%, 74%, and 95% of individual segments, respectively (P <.001). Wall motion scoring was altered in 17% of segments with contrast echocardiography and in 8% with tissue harmonics. Interobserver agreement on wall motion scoring was 84% to 88%. Contrast echocardiography permitted measurement of ejection fraction 45% (P =.003) more often over fundamental mode versus a 27% (P =.09) increase with tissue harmonics.
Conclusions:
Contrast echocardiography is superior to tissue harmonic imaging for EBD, wall motion scoring, and quantification of ejection fraction in mechanically ventilated patients.