Feasibility and Diagnostic Potential of Pulmonary Transit Time Measurement by Contrast Echocardiography: A Pilot Study.

AIMS: Pulmonary transit time (PTT; the time for ultrasound contrast to travel from the right ventricle [RV] to the left atrium) may provide a single metric that reports on cardiopulmonary function while overcoming some of the challenges of standard echocardiographic measures. We conducted a pilot study to test the feasibility and reproducibility of echocardiographically derived PTT and to determine its association with established measures of cardiopulmonary function. METHODS AND RESULTS: A total of 39 patients receiving clinically indicated ultrasound contrast were prospectively enrolled. PTT was measured in the apical four-chamber view using commercially available software. Reproducibility and inter-observer agreement were assessed in 9 patients. PTT was correlated with established measures of left ventricular systolic and diastolic function, RV function, and pulmonary vascular status. PTT could be measured in 89% (33/37) of patients without a contraindication to ultrasound contrast; all measurements from the last 20 patients were interpretable and obtained independently by a sonographer. Reproducibility and inter-observer agreement were excellent. PTT correlated well with standard echocardiographic indicators of cardiac status. A PTT >4.5 seconds accurately identified all but 1 patient with cardiopulmonary dysfunction. CONCLUSIONS: This pilot study demonstrates that measurement of PTT using ultrasound contrast is highly reproducible, accurately reflects global cardiopulmonary function across a range of cardiopulmonary disease, and can be readily obtained by an independent sonographer. Further studies are needed to determine whether PTT has incremental value in diagnosis and prognosis compared to conventional echocardiographic parameters.

Dobutamine Stress Echocardiography for the Bedside Assessment of Viability Following a Motor Vehicle Accident and Subsequent Myocardial Infarction: A Case Report.

The authors describe a case of a critically ill patient presenting after motor vehicle trauma complicated by anterior myocardial infarction and cardiogenic shock. Assessment of myocardial viability in the territory of a critically stenosed left anterior descending artery (LAD) was necessary to determine the optimal management strategy. Bedside dobutamine stress echocardiography (DSE) demonstrated viability in the LAD territory and the patient underwent uncomplicated single-vessel bypass surgery with subsequent improvement in left-ventricular function. This case illustrates the utility of bedside DSE to assess myocardial viability in patients for whom other non-invasive modalities are not feasible.

The safety of deFinity and Optison for ultrasound image enhancement: a retrospective analysis of 78,383 administered contrast doses.

BACKGROUND: The purpose of this retrospective analysis was to define the incidence of severe adverse events after exposure to ultrasound contrast agents. METHODS: Data between January 1, 2001, and September 30, 2007, were collected using invited responses to an on-line web-based questionnaire from 1 general and 12 cardiac ultrasound laboratories. During a period of 4.5 +/- 2.4 years, a total of 66,164 doses of Definity (Lantheus Medical Imaging, North Billerica, MA) and 12,219 doses of Optison (GE Healthcare, Buckinghamshire, UK) were administered, reflecting contrast use in 5% of transthoracic and 28% of stress echocardiographic procedures. More than 10,000 doses were given to critically ill patients in intensive care unit settings or to patients with acute chest pain of suspected cardiac origin. The median age of patients who received an ultrasound contrast agent was 60 years, 49% were male, and the mean body mass index was 32 +/- 1.4 g/m(-2). RESULTS: Severe reactions that were considered "probably" related to an ultrasound contrast agent developed in 8 patients (0.01%), all of whom were outpatients, and 4 (0.006%) of these were consistent with anaphylactoid reactions. There were no deaths reported. All patients recovered with treatment. No serious events were seen in inpatients. CONCLUSION: This multicenter, retrospective analysis includes the largest number of doses of ultrasound contrast agents ever published and a large number of patients evaluated in a wide variety of settings, including the critically ill. It shows that these agents have a good safety profile in both cardiac and abdominal ultrasound applications. The incidence of severe adverse reactions to ultrasound contrast agents is no greater, and may be lower, than that reported for contrast agents commonly used in other cardiac imaging tests.

Quill: a novel approach to structured reporting.

The authors will demonstrate Quill (QUestions and Information Logically Linked), a comprehensive structured reporting environment for ambulatory care that was developed at the Vanderbilt University Medical Center. A notes capture tool was sought with the immediate hope of decreasing or eliminating transcription costs (currently around $6M/yr) and paper based processing while providing a foundation for decision support and research in the future.