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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.


DEFINITY® is indicated, after activation, for use in adult and pediatric patients with suboptimal echocardiograms to opacify the left ventricular chamber and to improve the delineation of the left ventricular endocardial border.



Serious cardiopulmonary reactions, including fatalities, have occurred uncommonly during or following perflutren-containing microsphere administration. Most serious reactions occur within 30 minutes of administration.

  • Assess all patients for the presence of any condition that precludes DEFINITY® administration [see Contraindications (4)].
  • Always have resuscitation equipment and trained personnel readily available [see Warnings and Precautions (5.1)].