R. Pascoe

Detection of Right-to-Left Atrial Communication Using Agitated Saline Contrast Imaging: Experience with 1162 Patients and Recommendations for Echocardiography

BACKGROUND Right-to-left shunting via a patent foramen ovale (PFO) has a recognized association with embolic events in younger patients. The use of agitated saline contrast injection (ASCi) for detecting atrial shunting is well documented, but the optimal technique is not well described. The purpose of this study was to assess the efficacy and safety of transthoracic echocardiographic (TTE) ASCi for the assessment of right-to-left atrial communication in a large cohort of patients. METHODS A retrospective review was undertaken of 1,162 consecutive patients who underwent TTE ASCi, of whom 195 had also undergone clinically indicated transesophageal echocardiography. ASCi shunt results were compared with color flow imaging, and the role of provocative maneuvers (PM) was assessed. RESULTS Four hundred three TTE studies (35%) had paradoxical shunting seen during ASCi. Of these, 48% were positive with PM only. There was strong agreement between TTE ASCi and reported transesophageal echocardiographic findings (99% sensitivity, 85% specificity), with six false-positive and two false-negative results. In hindsight, the latter were likely due to suboptimal right atrial opacification and the former to transpulmonary shunting. TTE color flow imaging was found to be insensitive (22%) for the detection of a PFO compared with TTE ASCi. CONCLUSIONS TTE color flow imaging is too insensitive for PFO screening. TTE ASCi, however, is simple and highly accurate for the detection of right-to-left atrial communication, on the proviso that a dedicated protocol, including correctly implemented PM, is followed. It is recommended that TTE ASCi with PM be considered the primary diagnostic tool for the detection of PFO in clinical practice.

The safety profile of perflutren microsphere contrast echocardiography during rest and stress imaging: Results from an Australian multicentre cohort

BACKGROUND Contrast enhanced echocardiography (CEE) is utilised when sub-optimal image quality results in non-diagnostic echocardiograms. However, there have been numerous safety notices issued by regulatory authorities regarding rare but potentially serious adverse reactions (AR). This multi-centre, retrospective analysis was performed to assess the short-term safety of CEE in a broad range of indications. METHODS All CEE performed over 58 months at three institutions were assessed for AR within 30 min. RESULTS A total of 5956 CEE were performed in 5576 patients. A total of 4903 were stress CEE and 1053 resting CCE. Bolus administration in 5719, infusion in 237 cases; 89.9% of CCE were outpatients. Commonest CEE indication was functional stress testing (82.3%). There were 16 AR related to CEE (0.27%). All AR were mild, transient and all patients made a full recovery. No cases of serious anaphylaxis or death within 30 min of contrast administration. Comparing those with and without an AR, there were no significant differences in age, gender, BMI, LVEF, patient location, exam type or RVSP. There was a slightly increased likelihood of an AR during infusion versus bolus dosing (p = 0.02). CONCLUSION CEE is a safe investigation in a broad range of indications and clinical scenarios. AR are very rare, mild and transient.

Implementation of Secure Wireless Data Transmission on 12-lead ECG Improves Workflow in a Tertiary Hospital

of Cardiology Guidelines) who underwent of FFR assessment of at least one epicardial stenosis. Patient characteristics, procedural data and safety were analysed. Results: Eight patients (4 male, 4 female) were identified in the period from January 2010 to March 2012. Median age 84 years (62–92). Median baseline and post adenosine FFR were 0.91 and 0.86 respectively. Echocardiographic parameters: median LVEF 66% (52–79%), medianAV area 0.8 cm2, medianmeanAVpressure gradient 51.5mmHg, median peak AV velocity 4.5m/s, median dimensionless performance index 0.2. Procedural success was 100%. There were no periprocedural complications related to FFR evaluation in this group. No patient developed acute deterioration necessitating haemodynamic support. Conclusions: This cohort demonstrates that FFR assessment can be performed safely in the setting of severe AS. However, the validity of FFR measurement in this population requires further investigation. http://dx.doi.org/10.1016/j.hlc.2012.05.583