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Event Rates for Commonly Performed Cardiovascular Procedures. Complete List of Contraindications to Ultrasound Contrast Agents. Right-to-left, bi-directional, or transient right-to-left cardiac shunts Worsening or clinically unstable heart failure - PowerPoint PPT Presentation
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Event Rates for Commonly Performed Event Rates for Commonly Performed Cardiovascular ProceduresCardiovascular Procedures
Procedure Event Rate Event
CoronaryAngiography
1:1000 Death
Exercise TreadmillTesting
1:2500 MI or Death
SPECT Exam orRadionuclideVentriculography
1:1000 to1:10,000
Fatal Malignancy
ContrastEchocardiography
1:500,000 Death
Complete List of Contraindications to Complete List of Contraindications to Ultrasound Contrast AgentsUltrasound Contrast Agents
Right-to-left, bi-directional, or transient right-to-left Right-to-left, bi-directional, or transient right-to-left cardiac shuntscardiac shunts
Worsening or clinically unstable heart failureWorsening or clinically unstable heart failure Acute myocardial infarction or acute coronary syndromesAcute myocardial infarction or acute coronary syndromes Serious ventricular arrhythmias or high risk for Serious ventricular arrhythmias or high risk for
arrhythmias due to prolongation of the QT intervalarrhythmias due to prolongation of the QT interval Respiratory failure, as manifest by signs or symptoms of Respiratory failure, as manifest by signs or symptoms of
carbon dioxide retention or hypoxemiacarbon dioxide retention or hypoxemia Severe emphysema, pulmonary emboli or other Severe emphysema, pulmonary emboli or other
conditions that cause pulmonary hypertension due to conditions that cause pulmonary hypertension due to compromised pulmonary arterial vasculaturecompromised pulmonary arterial vasculature
Hypersensitivity to perflutrenHypersensitivity to perflutren
Complete List of Absolute Complete List of Absolute Contraindications to Cardiac Contraindications to Cardiac
CatheterizationCatheterization
“The only absolute contraindication to cardiac catherization is refusal of a
mentally competent patient to consent to the procedure”
Grossman W. Current practice standards. In: Baim DS and Grossman W, editors. Cardiac Catheterization, Angiography and Intervention. Baltimore, MD: Williams and Wilkins, 1996:9-16
PseudocomplicationPseudocomplication
Complications occurring after anyComplications occurring after any
medical pocedure may be attributable to medical pocedure may be attributable to the procedure itselfthe procedure itself progression of underlying disease state progression of underlying disease state
(pseudocomplication)(pseudocomplication)
PseudocomplicationPseudocomplication
Event -24 hour to cath Cath +72 hour
SAE 0.81% 0.81%
Death 0.24% 0%
Hildner et al. Pseudocomplications of cardiac catherization. Chest 1973;63:15-17
Serious adverse events are relatively common in patients who are “sick enough” to warrant invasive testing
ACC/AHA/ASE 2003 Guidelines Update for the ACC/AHA/ASE 2003 Guidelines Update for the Clinical Application of EchocardiographyClinical Application of Echocardiography
ACC/AHA/ASE 2003 Guidelines Update for the ACC/AHA/ASE 2003 Guidelines Update for the Clinical Application of EchocardiographyClinical Application of Echocardiography
“Echocardiographic contrast agents may improve diagnosis in free wall rupture and in identifying intracardiac thrombus.”
Contrast Echocardiography is Superior to Contrast Echocardiography is Superior to Tissue Harmonics for Assessment of Left Tissue Harmonics for Assessment of Left
Ventricular Function in Mechanically Ventricular Function in Mechanically Ventilated PatientsVentilated Patients
0
10
20
30
40
50
60
70
80
90
Harmonics Contrast
%
Conversion of non-diagnostic to diagnostic study
Kornbluth et al. Am Heart J 2000;140:291-6
Contrast Echocardiography is Superior to Tissue Contrast Echocardiography is Superior to Tissue Harmonics for Assessment of Left Ventricular Harmonics for Assessment of Left Ventricular Function in Mechanically Ventilated PatientsFunction in Mechanically Ventilated Patients
0102030405060708090
100
Fundamental Harmonics Contrast
%
1/5 of mechanically ventilated patients will require TEE if contrast contraindicated
Kornbluth et al. Am Heart J 2000;140:291-6
Wall motion scoring possible
Contrast Echocardiography Clarifies Contrast Echocardiography Clarifies Uniterpretable Wall Motion in Intensive Uniterpretable Wall Motion in Intensive
Care Unit PatientsCare Unit Patients
0
5
10
15
20
25
Fundamental Harmonic Contrast
%
% of patients with uniterpretable left ventricular function
Reilly JP et al. J Am Coll Cardiol 2000;35:485-90
Diagnostic Accuracy and Cost-Effectiveness of Diagnostic Accuracy and Cost-Effectiveness of Contrast Echocardiography on Evaluation of Cardiac Contrast Echocardiography on Evaluation of Cardiac Function in Technically Very Difficult Patients in the Function in Technically Very Difficult Patients in the
Intensive Care UnitIntensive Care Unit
0102030405060708090
100
Fundamental Harmonic Contrast TEE
%
Excellent or Adequate Endocardial Visualization
Yong et al. Am J Cardiol 2002;89:711-718
Complications of Transesophageal Complications of Transesophageal EchocardiographyEchocardiography
Seward JB et al. J Am Soc Echocardiogr 1992;5:228
Complications of Transesophageal Complications of Transesophageal EchocardiographyEchocardiography
Mortality rate = 1/10,000
Daniel WG et al. Circulation 1991;83:17-821
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