title: Contrast echocardiography can save nondiagnostic exams in mechanically ventilated patients.
abstract: Patients in an intensive care unit (ICU) under mechanical ventilation (MV) are very difficult to image by transthoracic echocardiography, diminishing the beneficial information that could be obtained by this noninvasive approach. The objective of this study is to assess whether the addition of a contrast agent to fundamental imaging (FI) can improve or change the initial diagnosis in cardiac postoperative patients under mechanical ventilation by enhancing endocardial border delineation and Doppler flow signal. Thirty mechanically ventilated post-cardiac surgery patients (20 men, mean age 61 +/- 13 years) were evaluated with FI before and after intravenous injection of contrast. Left ventricular endocardial border delineation score index (EBDSI), estimated left ventricular ejection fraction (LVEF), and color and spectral Doppler were analyzed. The use of contrast resulted in a significant increase in the number of well-delineated segments, with a salvage rate of 77% of nondiagnostic studies. EBDSI was 1.62 +/- 0.61, before contrast, increasing to 2.05 +/- 0.53 after it (P < 0.001). There was a change in the LVEF estimation in 5 exams, and a new wall motion abnormality was detected in other 4 exams, after the use of contrast. Moreover, a significant change was observed in the quantification of mitral regurgitation in 5 patients, in the aortic transvalvular peak gradient in 1 patient, and measurement of tricuspid regurgitation peak flow velocity in 8 patients. It is concluded that in cardiac postoperative patients under mechanical ventilation, intravenous injection of a contrast agent using FI resulted in a high salvage rate of studies and changed the initial diagnosis in a significant number of patients.
authors.affiliation: Heart Institute (InCor), University of São Paulo Medical School, Brazil.
authors.forename: Joicely M
authors.initials: JM
authors.lastname: Costa
authors.forename: Jeane M
authors.initials: JM
authors.lastname: Tsutsui
authors.forename: Emília
authors.initials: E
authors.lastname: Nozawa
authors.forename: Samira S
authors.initials: SS
authors.lastname: Morhy
authors.forename: José L
authors.initials: JL
authors.lastname: Andrade
authors.forename: José F
authors.initials: JF
authors.lastname: Ramires
authors.forename: Wilson
authors.initials: W
authors.lastname: Mathias
mesh_terms: D000418:Albumins / Q000008:administration & dosage; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D001783:Blood Flow Velocity / Q000502:physiology; D003287:Contrast Media / Q000008:administration & dosage*; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D005466:Fluorocarbons / Q000008:administration & dosage; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D011182:Postoperative Care / Q000379:methods; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D015203:Reproducibility of Results; D012121:Respiration, Artificial; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D000418:Albumins; D003287:Contrast Media; D005466:Fluorocarbons