title: CUTE-CV: a prospective study of enhanced left atrial appendage visualization with microbubble contrast agent use during transesophageal echocardiography guided cardioversion.
abstract: OBJECTIVE
  The aim of our study was to demonstrate that the use of contrast microbubbles during transesophageal echocardiography (TEE) guided cardioversion will improve interpretation of the TEE images.
  
  
  BACKGROUND
  TEE-guided cardioversion of atrial flutter or fibrillation (AF) is a safe and proven method to restore sinus rhythm. However, artifacts and dense spontaneous echo contrast in the left atrial appendage (LAA) can sometimes decrease the level of confidence in excluding the presence of thrombus.
  
  
  METHODS
  One hundred patients referred for TEE-guided cardioversion were prospectively enrolled and microbubble contrast agent (DEFINITY) was administered after the clinical decision had been made regarding suitability for cardioversion. Noncontrast and contrast images were compared during subsequent offline analysis.
  
  
  RESULTS
  LAA dimensions and contractility indices were higher, artifacts were significantly differentiated, previously unsuspected LAA filling defects were identified, and the level of confidence in excluding thrombus was enhanced in the contrast images when compared to the noncontrast images. After 4 months follow-up, 1 stroke-associated death occurred in a patient who had LAA thrombus recognized only by contrast. Left atrial appendage visualization is enhanced with microbubble contrast agent use during transesophageal echocardiography guided cardioversion and is useful in identification of intracardiac thrombus.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Quebec Heart and Lung Institute, Québec, Canada.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Bernier
authors.forename: Sahar S
authors.initials: SS
authors.lastname: Abdelmoneim
authors.forename: W
authors.initials: W
authors.lastname: Stuart Moir
authors.forename: Susan Sue J
authors.initials: SS
authors.lastname: Eifert Rain
authors.forename: Krishnaswamy
authors.initials: K
authors.lastname: Chandrasekaran
authors.forename: Naser M
authors.initials: NM
authors.lastname: Ammash
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Mulvagh
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D001282:Atrial Flutter / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D003287:Contrast Media; D017548:Echocardiography, Transesophageal / Q000706:statistics & numerical data; D004554:Electric Countershock / Q000706:statistics & numerical data*; D005260:Female; D005466:Fluorocarbons; D006801:Humans; D008297:Male; D045423:Microbubbles; D008910:Minnesota; D015995:Prevalence; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000706:statistics & numerical data
chemical_list: D003287:Contrast Media; D005466:Fluorocarbons; C042852:perflutren
keywords: TEE; contrast echocardiography; left atrial appendage thrombus; left atrium; thrombus