Contrast echocardiography clarifies uninterpretable wall motion in intensive care unit patients

OBJECTIVES The study examined the value of contrast echocardiography in the ventricular (LV) wall motion in intensive care unit (ICU) patients. BACKGROUND Echocardiograms done in the ICU are often suboptimal. The most c ommon indication is the evaluation of LV wall motion and ejection fraction (EF). METHODS Transthoracic echocardiograms were done in 70 unselected ICU patien ts. Wall motion was evaluated on standard echocardiography (SE),: harmonic echocardiography (HE), and after intravenous (IV) contrast echocardiography (CE) using a score for each of 16 segments. A confidence score was also gi ven for each segment with:each technique (unable to judge; not sure; sure). The EF was estimated visually for each technique, and a confidence score w as applied to the EF. RESULTS Uninterpretable wall motion was present in 5.4 segments/patient on SE, 4.4 on HE (p = 0.2), and 1.1 on CE (p < 0.0001). An average of 7.8 segm ents were read with surety on SE, 9.2 on HE (p = 0.1), and 13.7 on CE (p < 0.0001). Ejection fraction was uninterpretable in 23% on SE, 13% on HE (p = 0.14), and 0%, On CE (p = 0.002 vs. HE; p < 0.0001 vs. SE). The EF was rea d with surety in 56% of patients on SE, 62% on HE (p = 0.47), and 91% on CE (p < 0.0001). Thus, wall motion was:seen with more confidence on CE. More importantly, the actual readings of segmental wall motion and EF significan tly differed using CE. CONCLUSIONS CE should be used in all ICU patients with suboptimal transthor acic echocardiograms. (J Am Coll Cardiol 2000;35:485-90) (C) 2000 by the Am erican College of Cardiology.