Contrast echocardiography in Australian clinical practice

Area of Science:

• Cardiology
• Medical Imaging
• Pharmacology

Background:

• Introduction of Definity (perflutren microsphere), a second-generation contrast agent, in Australia in mid-2007.
• Implementation of contrast echocardiography in a high-volume quaternary teaching hospital with over 16,000 echocardiograms annually.
• Development of specific workflow protocols for patient selection, contrast administration, and image acquisition/analysis.

Purpose of the Study:

• To evaluate the introduction and impact of contrast echocardiography in a clinical setting.
• To assess the effectiveness of Definity in improving image quality and diagnostic accuracy.
• To determine the safety and feasibility of contrast echocardiography in Australian practice.

Main Methods:

• Prospective data collection for 161 patients receiving contrast echocardiography within the first 12 months.
• Quantitative assessment of endocardial definition scores by three independent observers before and after contrast administration.
• Statistical comparison of pre- and post-contrast scores and analysis of inter-observer variability.

Main Results:

• Statistically significant improvement in endocardial definition scores (p=0.0001) post-contrast administration.
• Reduced inter-observer variability in wall motion assessment.
• Detection of clinically significant findings (e.g., pseudoaneurysm, non-compaction, thrombus) missed by standard 2D imaging; rare adverse events (0.6%).

Conclusions:

• Contrast echocardiography with Definity significantly enhances endocardial definition and diagnostic yield.
• The technique is safe and effective, providing crucial diagnostic information in challenging cases.
• Contrast echocardiography is feasible and beneficial in Australian clinical practice, improving diagnostic accuracy and reducing variability.