Evaluation of appropriate use of transthoracic echocardiography in 1,820 consecutive patients using the 2011 revised appropriate use criteria for echocardiography.

Revised Appropriate Use Criteria (AUC) for Echocardiography were published in 2011 and classify potential procedure indications as appropriate (score of 7 to 9), uncertain (score of 4 to 6), or inappropriate (score of 1 to 3). The appropriate utilization rate of transthoracic echocardiography in clinical practice using the revised AUC is unknown. The aim of the present study was to determine the appropriate utilization rate of echocardiography in a large number of consecutive studies in clinical practice and to determine the number of "unclassifiable" studies using the revised and expanded AUC.

Appropriate use of transthoracic echocardiography.

The appropriateness criteria for echocardiography were published in 2007 and classified potential procedural indications as appropriate, uncertain, or inappropriate. The appropriate use rates for outpatient transthoracic echocardiography (TTE) by cardiologists have not been well defined. The objective of the present study was to prospectively determine the appropriate use rate of outpatient TTE in a large private practice group of >40 cardiologists (Cardiovascular Consultants, PA, Kansas City, Missouri).

Appropriate utilization of transesophageal echocardiography.

Appropriateness criteria for echocardiography were recently published and classify potential procedural indications as appropriate (scores of 7 to 9), uncertain (scores of 4 to 6), or inappropriate (scores of 1 to 3). The rate of the appropriate utilization of transesophageal echocardiography (TEE) in clinical practice is unknown. The aim of this study was to determine the appropriate utilization rate of TEE in a large consecutive patient series.

Temporal obesity trends in patients undergoing transthoracic echocardiography 2002-2006.

In a recent data brief, the National Center for Health Statistics reported that obesity prevalence has plateaued in recent years, with no increase in obesity from 2003 to 2006. We have subjectively observed a marked increase in clinically severe obesity over this same period in patients presenting to our echocardiographic laboratory. The aim of this study was to determine temporal trends in obesity prevalence in patients presenting for transthoracic echocardiographic studies.

Combined assessment of myocardial perfusion and diastolic function enhances risk stratification in patients with anterior wall myocardial infarction.

Objective: Evaluate the utility of a combined risk stratification scheme including diastolic dysfunction and "no-reflow," to identify high-risk patients following acute myocardial infarction (AMI).

Background: Recent studies have demonstrated that the "no-reflow" phenomenon (defined by myocardial contrast echocardiography) and severe diastolic dysfunction (identified by Doppler echocardiography) identify patients at high risk for mortality following AMI.

Methods: We evaluated 111 patients with recent anterior acute myocardial infarction from July 2000 to June 2004.

Acute mortality in hospitalized patients undergoing echocardiography with and without an ultrasound contrast agent (multicenter registry results in 4,300,966 consecutive patients).

We sought to define acute mortality in a large multicenter cohort of hospitalized patients undergoing clinically indicated echocardiography with and without use of an ultrasound contrast agent. Although the United States Food and Drug Administration recently relaxed the issued warnings for perflutren-containing ultrasound contrast agents on May 13, 2008, concerns still exist regarding the safety of these compounds, particularly in critically ill patients. A retrospective analysis was performed using the Premier Perspective Database.

Acute mortality in hospitalized patients undergoing echocardiography with and without an ultrasound contrast agent: results in 18,671 consecutive studies.

Objectives: We sought to define acute mortality in hospitalized patients undergoing clinically indicated echocardiography with and without use of an ultrasound contrast agent.

Background: The U.S.

Usefulness of myocardial contrast echocardiography in predicting late mortality in patients with anterior wall acute myocardial infarction.

We investigated whether myocardial contrast echocardiography (MCE) performed soon after acute myocardial infarction (AMI) improves risk stratification for late mortality. MCE after AMI identifies microvascular "no-reflow" and predicts early outcomes; however, the predictive value of MCE for late mortality is unknown. One hundred sixty-seven patients with anterior AMI and left ventricular dysfunction underwent MCE 2 days after admission, and a perfusion score index (PSI) was calculated.

Contrast administration reduces interobserver variability in determination of left ventricular ejection fraction in patients with left ventricular dysfunction and good baseline endocardial border delineation.

Echocardiographic contrast agents improve endocardial border delineation in patients with technically difficult baseline studies. With medical and device therapy for heart failure increasingly based on left ventricular (LV) ejection fraction (EF) partition values, the accurate and reproducible assessment of LV function is necessary. It was hypothesized that routine contrast enhancement would significantly reduce interobserver variability in the determination of LVEFs in a cohort of patients with LV dysfunction and good baseline endocardial delineation.

Myocardial contrast echocardiographic estimates of infarct size predict likelihood of left ventricular remodeling after acute anterior wall myocardial infarction.

Objectives: We sought to determine the utility of myocardial contrast echocardiography (MCE) in predicting left ventricular (LV) remodeling (LVR) in patients with a recent anterior wall myocardial infarction and residual regional LV akinesis.

Background: Although recent studies have shown that MCE predicts recovery of regional and global LV systolic function after myocardial infarction, the relationship between myocardial perfusion patterns and likelihood of subsequent LVR has not been extensively studied.

Methods: In all, 50 patients (mean age 62 years) underwent contrast-enhanced echocardiography for determination of LV volumes and ejection fraction, and MCE, 2 days after admission, with follow-up contrast-enhanced echocardiography 6 months later.

Usefulness of myocardial contrast echocardiography in predicting global left ventricular functional recovery after anterior wall acute myocardial infarction.

Although multiple recent studies have shown that myocardial contrast echocardiography (MCE) reliably differentiates between regional stunning and necrosis after acute myocardial infarction (AMI), prognosis is more closely related to measures of global left ventricular systolic function. One hundred fifteen patients underwent baseline wall motion assessment and MCE 2 days after admission and follow-up echocardiography a mean of 69 days later. Good agreement was found between perfusion score index and follow-up wall motion score index, indicating that MCE performed early after anterior wall AMI may be clinically useful in routine post-AMI risk stratification.

Reperfusion assessment using myocardial contrast echocardiography in patients with ST-segment elevation acute myocardial infarction.

In this study, 29 patients underwent myocardial contrast echocardiography after presentation with ST-segment elevation acute myocardial infarction but before coronary angiography using a continuous infusion of microbubbles and real-time imaging with a low mechanical index. Patients with transmural perfusion defects at presentation subsequently had much larger infarctions (as measured by peak creatine phosphokinase-MB fraction) than did those with normal perfusion, indicating that myocardial contrast echocardiography may be a useful means to determine adequacy of reperfusion after thrombolytic therapy and in the selection of patients for adjunctive treatment, such as "rescue angioplasty."

Real-time assessment of myocardial perfusion during balloon angioplasty of the left anterior descending coronary artery.

Balloon occlusion and release during elective percutaneous coronary intervention (PCI) provides a unique opportunity to study dynamic temporal alterations in myocardial perfusion in a controlled setting. These changes in flow and volume mimic those that occur during presentation with, and successful therapy of, ST-segment elevation acute myocardial infarction (AMI). Eleven patients underwent myocardial contrast echocardiography (MCE) using a continuous infusion of Definity at baseline, during coronary occlusion, and during reactive hyperemia immediately after balloon deflation.