title: Contrast echocardiography in Australian clinical practice.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Echocardiography, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia. chamiltoncraig@gmail.com
authors.forename: Christian
authors.initials: C
authors.lastname: Hamilton-Craig
authors.forename: Tau
authors.initials: T
authors.lastname: Boga
authors.forename: Cathy
authors.initials: C
authors.lastname: West
authors.forename: Natalie
authors.initials: N
authors.lastname: Kelly
authors.forename: Russell
authors.initials: R
authors.lastname: Anscombe
authors.forename: Darryl
authors.initials: D
authors.lastname: Burstow
authors.forename: David
authors.initials: D
authors.lastname: Platts
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003287:Contrast Media / Q000008:administration & dosage*; D019091:Critical Pathways; D004452:Echocardiography / Q000379:methods* / Q000706:statistics & numerical data; D005080:Exercise Test; D005466:Fluorocarbons / Q000008:administration & dosage; D006784:Hospitals, Teaching; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D057188:Workflow
chemical_list: D003287:Contrast Media; D005466:Fluorocarbons; C042852:perflutren