Contrast microbubbles improve diagnostic yield in ICU patients with poor echocardiographic windows.
OBJECTIVE
To determine the value of contrast echocardiographic studies in patients admitted to ICUs who have poor echocardiographic windows secondary to COPD, ventilator use, or inability to obtain optimal positioning for the echocardiogram.


METHODS
A prospective comparison study of technically difficult patients in the ICU.


METHODS
The total scores for the left ventricle (LV) in the two-chamber and four-chamber views were calculated at baseline and following injection of 1 to 2 mL of a contrast agent. The mean numbers of segments visualized in all patients at baseline and after injection of contrast agent were compared to assess the effect on improved visualization.


RESULTS
Forty consecutive patients underwent echocardiography in the ICU for evaluation of LV function. Of these, 25 patients (63%) had poor visualization of the endocardium and required IV contrast agent. In these 25 patients, the average baseline segmental score was 4.5, compared to 11.6 in patients who received an IV contrast agent. Nineteen patients had an average baseline segmental score of 3.9 and were deemed to have a nondiagnostic study. After administration of IV contrast, all patients converted to a diagnostic study, with an average score of 11.6 segments visualized.


CONCLUSIONS
Use of echocardiographic contrast agents in selected patients with poor baseline echocardiographic windows in the ICU setting significantly enhances segmental LV visualization and yielded 100% conversion from nondiagnostic to diagnostic studies.
Nguyen
T T
TT
University of California, Davis Medical Center, Sacramento, CA, USA.
Dhond
M R
MR
Sabapathy
R
R
Bommer
W J
WJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins; D003287:Contrast Media; D003422:Critical Care; D004452:Echocardiography; D005260:Female; D005466:Fluorocarbons; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D011237:Predictive Value of Tests; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000000981:diagnostic imaging*; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*
D000418:Albumins; D003287:Contrast Media; C099458:FS 069; D005466:Fluorocarbons