title: Clinical impact of second harmonic imaging and left heart contrast in echocardiographic stress testing.
abstract: Second harmonic imaging and left heart contrast agents are recent echocardiographic advancements that enhance the assessment of wall motion. Because little information exists concerning their clinical impact on echocardiographic stress testing in daily practice, this was determined for 9-month periods before (1997) and after (1998) their introduction. Harmonic imaging was used in all patients after its introduction. A second generation intravenous left heart contrast agent (Optison) was used at the discretion of the sonographer and physician team. Both exercise and dobutamine stress tests were included. At the time of study interpretation, diagnostic confidence was assigned as high, medium, or low. For all patients who underwent coronary angiography < or = 6 months after stress testing, the diagnostic accuracy was determined (true positive plus true negative/total studies). There were 574 studies before and 746 studies after implementation. Optison was used in 28% of the harmonic imaging studies. Study cancellations due to uninterpretable images fell from 6.4% to 1.2% (p <0.001) despite a more obese population completing testing (body mass index: 29 +/- 7 to 31 +/- 8 kg/m2, p = 0.02), whereas high diagnostic confidence increased from 55% to 64% (p <0.001). For the 7% of patients who underwent cardiac catheterization, the diagnostic accuracy remained unchanged (74 vs 73%) although a prior negative stress test was less common (40% to 20% p = 0.04). Thus, these new technologies had a favorable clinical impact.
authors: Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio 44109-1900, USA. rfinkelhor@metrohealth.org
authors: R S
authors: RS
authors: Finkelhor
authors: M
authors: M
authors: Pajouh
authors: A
authors: A
authors: Kett
authors: R
authors: R
authors: Stefanski
authors: G
authors: G
authors: Bosich
authors: M E
authors: ME
authors: Youssefi
authors: R C
authors: RC
authors: Bahler
mesh_terms: D000418:Albumins; D006328:Cardiac Catheterization; D003287:Contrast Media; D025401:Echocardiography, Stress / Q000379:methods; D005080:Exercise Test; D005260:Female; D005466:Fluorocarbons; D006801:Humans; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000418:Albumins; D003287:Contrast Media; C099458:FS 069; D005466:Fluorocarbons