Contrast echocardiography in Australian clinical practice

The second-generation contrast agent Definity (a perflutren microsphere) became available in Australia in mid-2007. We describe the introduction of contrast echocardiography into a high-volume quaternary teaching hospital, performing over 16,000 echocardiograms per year. Workflow protocols were developed for patient selection, contrast administration, and image acquisition and analysis.

Data were prospectively collected for all contrast cases. Endocardial definition scores were derived by three independent observers before and after contrast administration, and statistically compared.

161 patients received contrast in the first 12 months of the contrast program. There was statistically significant improvement in endocardial definition scores after contrast administration (p=0.0001), and reduction in inter-observer variability of wall motion assessment. A number of clinically significant findings (pseudoaneurysm, non-compaction, thrombus) were detected on contrast echo that were not apparent on standard 2D imaging. Adverse events were rare (0.6%) with no life-threatening events.

The introduction of a second-generation contrast agent into clinical workflow in a hospital echocardiography department resulted in a statistically significant improvement in endocardial definition, and safely provided diagnostic imaging in cases which were otherwise non-diagnostic. Inter-observer variability was reduced, and diagnostic yield increased. These results reflect previously published data, and indicate that contrast echocardiography is feasible in Australian clinical practice.