Echocardiographic imaging of technically difficult patients in the intensive care unit: Use of Optison in combination with fundamental and harmonic imaging

Previous studies of intravenous contrast agents have excluded patients in t he intensive care unit. These patients remain among the most technically di fficult to image with ultrasound. We studied the effect of different imagin g modalities with and without intravenous contrast (Optison) on endocardial border visualization during echocardiography. Fifty patients in the intens ive care unit (32 men, 24 on mechanical ventilator, 10 with chest bandages; mean age, 59 years; mean weight, 91.7 kg; mean height, 67.6 inches) were c onsidered to have technically difficult images when the endocardium could n ot be visualized in at least 2 of the 6 segments in either apical view. Eac h patient was studied with the use of fundamental (F), harmonic (H), fundam ental + Optison (F + O), and H + O techniques, with standard long-axis, sho rt-axis, and apical 4- and 2-chamber views. Intravenous Optison (0-5 to 1.5 mL) was given before F + O and H + O imaging. There were no contrast-relat ed side effects noted. All images were stored digitally in a quad-screen fo rmat. For each set of images, segments (n = 22) were given an endocardial b order visualization score of 0 if not visualized, I if visualized in either systole or diastole, and 2 if visualized in both. There was stepwise impro vement in endocardial border visualization, with mean endocardial border vi sualization score of 1.09 +/- 0.83 (F), 1.33 +/- 0.81 (H), 1.64 +/- 0.62 (F + O), and 1.90 +/- 0.35 (H + O). There was a statistically significant dif ference between each group (P < .001). The incremental benefit of Optison w as greater with harmonic imaging than with fundamental (P < .001). The use of Optison is safe and effective in the intensive care unit. In combination with harmonic imaging, contrast provides maximal endocardial border deline ation during echocardiographic imaging of technically difficult patients in the intensive care unit.