Contrast Echocardiography in Australian Clinical Practice

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. [Copyright &y& Elsevier]