title: Contrast echocardiography improves the diagnostic yield of transthoracic studies performed in the intensive care setting by novice sonographers.
abstract: BACKGROUND
  Bedside portable echocardiography in the intensive care department (ICU) is technically difficult, but crucial for directing patient care. Prior studies have shown contrast echocardiography (CE) in the ICU clarifies left ventricular wall motion when performed by experienced sonographers (ESO). However, in most hospitals, ESO are unavailable around the clock, and less experienced cardiovascular fellows or trainees may be asked to perform these examinations.
  
  
  METHODS
  Transthoracic echocardiograms were retrospectively evaluated by level III trained echocardiographers for 213 patients in the ICU. Most were performed to assess left ventricular function (65% or 139 of 213) and were scanned by cardiology fellows (70% or 149 of 213) with less than 3 months echocardiography experience. Contrast agent was used in 29% (62 of 213) of all patients.
  
  
  RESULTS
  The conversion of suboptimal or diagnostically inadequate apical 4- and 2-chamber views to diagnostically adequate with contrast was statistically significant when performed by both cardiology fellows and ESO (Fischer exact test, P < .0002).
  
  
  CONCLUSIONS
  CE is effective in improving the diagnostic yield of transthoracic echocardiographic ICU studies performed by both novice sonographers and ESO. Using cardiology fellows to perform CE in this setting can be appropriate, particularly in after-hour situations, when ESO are not always available and the clinical question is left ventricular function. Results also suggest cardiology fellows can easily learn CE.
authors.affiliation: Division of Cardiology at North Shore University Hospital, New York University School of Medicine, Manhasset, New York, USA.
authors.forename: Amgad N
authors.initials: AN
authors.lastname: Makaryus
authors.forename: Michael E
authors.initials: ME
authors.lastname: Zubrow
authors.forename: Linda D
authors.initials: LD
authors.lastname: Gillam
authors.forename: Nickolaos
authors.initials: N
authors.lastname: Michelakis
authors.forename: Lawrence
authors.initials: L
authors.lastname: Phillips
authors.forename: Safi
authors.initials: S
authors.lastname: Ahmed
authors.forename: David
authors.initials: D
authors.lastname: Friedman
authors.forename: Cristina
authors.initials: C
authors.lastname: Sison
authors.forename: Smadar
authors.initials: S
authors.lastname: Kort
authors.forename: David
authors.initials: D
authors.lastname: Rosman
authors.forename: Judy R
authors.initials: JR
authors.lastname: Mangion
mesh_terms: D000368:Aged; D002983:Clinical Competence; D004452:Echocardiography / Q000379:methods / Q000592:standards*; D005260:Female; D006331:Heart Diseases; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007362:Intensive Care Units; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*