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Efficacy and time-efficiency of a "sonographer-driven" contrast echocardiography protocol in a high-volume
Ramon Castello1, Jonathan N Bella, Aleksandr Rovner
1Division of Cardiology, Department of Medicine, University Hospitals of Cleveland/Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. castello.ramon@mayo.edu
Insights
Contrast echocardiography (CE) improves left ventricular (LV) visualization and is time-efficient. A sonographer-driven protocol makes CE feasible and effective in high-volume labs.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Contrast echocardiography (CE) shows efficacy in assessing left ventricular (LV) function but lacks widespread adoption.
- Limited data exists on CE's clinical effectiveness and time efficiency in high-volume echocardiography settings.
Purpose of the Study:
- To determine if CE can be integrated effectively and efficiently into high-volume echocardiography laboratories.
- To assess the clinical utility and time impact of a sonographer-driven CE protocol for LV assessment.
Main Methods:
- Implementation of a "sonographer-driven" CE protocol with feasibility and established phases.
- Inclusion of 119 patients in the feasibility phase and 672 in the established phase.
- Cost-benefit analysis based on time utilization and blinded reader evaluation of image quality.
Main Results:
- CE improved LV visualization and wall thickening assessment compared to standard imaging.
- Decision and contrast administration times significantly decreased from the feasibility to the established phase.
- Obesity was the primary indication for CE; contrast studies represented 7-8% of total echocardiograms.
Conclusions:
- A sonographer-driven CE protocol is feasible and clinically effective for LV assessment in high-volume labs.
- CE significantly enhances visualization of LV global and regional wall motion.
- The protocol substantially reduces decision and administration times, improving overall time efficiency.
Background:
Contrast echocardiography (CE) has not gained widespread use despite numerous studies demonstrating its efficacy in the assessment of left ventricular (LV) function.
Methods:
We sought to determine whether CE could be used in a high-volume echocardiography laboratory in a clinically effective and time efficient manner. We implemented a protocol with a feasibility phase and an established phase. Cost-benefit analyses were done on the basis of time use.
Results:
During the feasibility and established phases, data on 119 and 672 patients, respectively, were obtained. After a "sonographer-driven" protocol, contrast studies represented 7% to 8% of the total number of routine transthoracic and stress studies. Stress studies accounted for only 15% of the total number of contrast studies. Obesity was the most common indication for contrast use. LV visualization indices and wall thickening assessment, as evaluated by 2 blinded readers, were significantly improved with CE compared with second harmonic imaging alone. The time to make the decision to use CE and the time taken to administer contrast decreased significantly from the feasibility phase to the established phase (8.3 +/- 5 vs 7.6 +/- 5 min, P <.01, and 13.4 +/- 10 vs 10.2 +/- 5 min, P <.001, respectively). On the basis of time use only, a cost analysis indicated that savings were obtained at a 10-minute reduction in study time.
Conclusions:
A "sonographer-driven" CE protocol for LV assessment is feasible in high-volume echocardiography laboratories. It is clinically effective because it significantly improves LV global and regional wall motion visualization. A "sonographer-driven" CE protocol can reduce decision and administration times substantially, thus making CE time-efficient.