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The Challenges of Nondiagnostic Echoes

Even with advancements in echocardiography, imaging can be suboptimal,1 which may lead to2:

  • Inadequate treatment plans
  • Unnecessary additional testing
  • Increased hospital stays
  • Avoidable hospital readmissions

Apical hypertrophic cardiomyopathy



How to Obtain Diagnostic Echoes

Implementing the American Society of Echocardiography (ASE) guidelines for ultrasound enhancing agents can help improve efficiency and patient care.3

A Summary from the ASE UEA Guidelines3:

  • When 2 or more LV segments cannot be visualized
  • In all patients for whom quantitative assessment of LVEF is important
  • For all technically difficult ICU and ED patients for quick and accurate diagnosis and to reduce additional diagnostic testing
  • In ED patients presenting with myocardial ischemia and nondiagnostic EKG
  • When LV thrombus cannot be ruled in or out
  • When structural abnormalities cannot be adequately assessed, such as noncompaction, apical hypertrophy, aneurysms
  • For diagnosis and exclusion of pseudoaneurysms

Create written policies for using ultrasound enhancing

Establish quality assessment and improvement programs4

Maintain personnel 
training and credentialing4

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  1. Lindner JR. A practical approach to contrast echocardiography. American College of Cardiology. Published July 10, 2017. Accessed May 27, 2021.​09/17/a-practical-approach-to-contrast-echocardiography

  2. Kurt M, Shaikh KA, Peterson L, et al. Impact of contrast echocardiography on evaluation of ventricular function and clinical management in a large prospective cohort. J Am Coll Cardiol. 2009;53(9):802-810.

  3. Porter TR, Mulvagh SL, Abdelmoneim SS, et al. Clinical applications of ultrasonic enhancing agents in echocardiography: 2018 american society of echocardiography guidelines update. J Am Soc Echocardiogr. 2018:31(3):241-274.

  4. Porter TR, Abdelmoneim S, Belcik JT, et al. Guidelines for the cardiac sonographer in the performance of contrast echocardiography: a focused update from the American Society of Echocardiography. J Am Soc Echocardiogr. 2014;27(8):797-810.