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Contrast harmonic imaging improves the evaluation of left ventricular function in ventilated patients: comparison
B Cosyns1, P El Haddad, H Lignian
1Academisch Ziekenhuis, Vrije Universiteit Brussel, Brussels, Belgium. bcosyns@skynet.be
Insights
Contrast echocardiography (CE) significantly improves visualization of left ventricular (LV) wall motion in ventilated patients compared to standard echocardiography (SE). CE offers image quality for LV function assessment comparable to transesophageal echocardiography (TOE).
Area of Science:
- Cardiology
- Medical Imaging
- Critical Care Medicine
Background:
- Standard echocardiography (SE) often provides suboptimal imaging of left ventricular (LV) function in ventilated patients.
- Assessing LV wall motion and ejection fraction (EF) is crucial for managing critically ill patients.
Purpose of the Study:
- To evaluate the effectiveness of contrast echocardiography (CE) in assessing LV wall motion.
- To compare CE with standard echocardiography (SE) and transesophageal echocardiography (TOE) in ventilated patients.
Main Methods:
- Transthoracic echocardiograms were performed on 40 ventilated patients.
- Wall motion and EF were assessed using SE, CE, and TOE, with visualization and confidence scores assigned.
- A scoring system evaluated image quality for 16 LV segments.
Main Results:
- CE significantly reduced segments with no visualization (1.2 vs. 6.2 for SE, P<0.0001).
- CE increased segments read with surety (11.5 vs. 6.5 for SE, P<0.0001) and interpretable EF (0% vs. 32% for SE, P<0.001).
- CE demonstrated comparable results to TOE for visualization and EF assessment.
Conclusions:
- Contrast echocardiography (CE) significantly enhances the assessment of LV wall motion and function in ventilated patients.
- CE provides image quality for LV function evaluation that is similar to transesophageal echocardiography (TOE).
- CE is a valuable tool for improving echocardiographic assessment in challenging patient populations.
Aims:
The study examined the value of contrast echocardiography (CE) in the assessment of left ventricular (LV) wall motion in ventilated patients in comparison with transesophageal (TOE) and standard fundamental transthoracic imaging (SE).
Methods:
Transthoracic echocardiograms were done in 40 ventilated patients. Wall motion was evaluated using the recommendations of the American Society of Echocardiography on SE, CE and TOE. A visualization score was assigned on a scale of 2-0 for each of 16 segments. The segment was assigned a value of 2 if the segment was seen in both systole and diastole, 1 if seen only in systole or diastole, and 0 if not seen at all. A confidence score was also given for each segment with each technique (unable to evaluate; not sure; sure). The ejection fraction (EF) was estimated visually for each technique, and a confidence score was also applied to the EF.
Results:
Visualization score 0 was present in 6.2 segments/patient on SE, 1.2 on CE (P<0.0001) and 1.1 on TOE (P<0.0001). An average of 6.5 segments were read with surety on SE, 11.5 on CE (P<0.0001) and 12.3 on TOE ( P<0.0001 ). There was no significant difference for CE vs TOE. EF was uninterpretable in 32% on SE, 0% on CE (P<0.001 and 0% on TOE (P<0.001). The EF was read with surety in 53% of patients on SE, 88% on CE (P < 0.0001) and 93% with TOE (P<0.0001) with no difference for CE vs TOE. Thus, wall motion was seen with more confidence on CE and TOE.
Conclusions:
In the ventilated patients with suboptimal transthoracic echocardiograms for the evaluation of the LV function, CE provides image quality of regional and global LV function similar to that achieved with TOE echocardiography.
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