Contrast harmonic imaging improves the evaluation of left ventricular function in ventilated patients: comparison with transesophageal echocardiography

doi:10.1016/S1525-2167(03)00054-4

European Journal of Echocardiography 2004 5(2):118-122; doi:10.1016/S1525-2167(03)00054-4
© 2004 by European Society of Cardiology

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Contrast harmonic imaging improves the evaluation of left ventricular function in ventilated patients: comparison with transesophageal echocardiography

B Cosyns^a^,*, P El Haddad^b, H Lignian^b, C Daniels^a, C Weytjens^a, D Schoors^a and G Van Camp^a

^aAcademisch Ziekenhuis, Vrije Universiteit Brussel, Brussels, Belgium
^bCHIREC—Site Braine-l'Alleud, Free University of Brussels, Brussels, Belgium

Received 14 November 2002; received in revised form 14 May 2003; accepted after revision 16 May 2003.

^* Corresponding author. Cardiology Department, AZ VUB, 101 Laarbeeklaan B-1090 Brussels, Belgium. Tel.: +32-23890440; fax: +32-23890312. bcosyns{at}skynet.be

Abstract

Aims: The study examined the value of contrast echocardiography(CE) in the assessment of left ventricular (LV) wall motionin ventilated patients in comparison with transesophageal (TOE)and standard fundamental transthoracic imaging (SE).

Methods: Transthoracic echocardiograms were done in 40 ventilatedpatients. Wall motion was evaluated using the recommendationsof the American Society of Echocardiography on SE, CE and TOE.A visualization score was assigned on a scale of 2–0 foreach of 16 segments. The segment was assigned a value of 2 ifthe segment was seen in both systole and diastole, 1 if seenonly in systole or diastole, and 0 if not seen at all. A confidencescore was also given for each segment with each technique (unableto evaluate; not sure; sure). The ejection fraction (EF) wasestimated visually for each technique, and a confidence scorewas also applied to the EF.

Results: Visualization score 0 was present in 6.2 segments/patienton SE, 1.2 on CE (P<0.0001) and 1.1 on TOE (P<0.0001).An average of 6.5 segments were read with surety on SE, 11.5on CE (P<0.0001) and 12.3 on TOE (P<0.0001). There wasno significant difference for CE vs TOE. EF was uninterpretablein 32% on SE, 0% on CE (P<0.001) and 0% on TOE (P<0.001).The EF was read with surety in 53% of patients on SE, 88% onCE (P<0.0001) and 93% with TOE (P<0.0001) with no differencefor CE vs TOE. Thus, wall motion was seen with more confidenceon CE and TOE.

Conclusions: In the ventilated patients with suboptimal transthoracicechocardiograms for the evaluation of the LV function, CE providesimage quality of regional and global LV function similar tothat achieved with TOE echocardiography.

Keywords: contrast harmonic echocardiography; transesophageal echocardiography; intensive care unit; ventilated patients; left ventricular function

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