The most utilized ultrasound enhancing agent is approved for use in pediatric patients
Data on file, Lantheus.
Case
Studies
Read About Real-World Experiences
With DEFINITY® in Multiple Care Settings
CASE STUDY: DEFINITY® IN THE CRITICAL CARE UNIT
52-year-old man
Patient with diabetes mellitus and a history of drug abuse presented with altered mental status, nausea, and vomiting. He complained of chest discomfort for a few days and was found to have evolving anterior ST-segment changes on an electrocardiogram.
Cardiac enzyme testing showed a normal troponin T level and a slightly elevated CK-MB index suggestive of a recent myocardial infarction.
CASE STUDY: DEFINITY® IN THE Emergent care setting
39-year-old man
Patient presented to the emergency department with chest pain. An electrocardiogram demonstrated an anterior and anterolateral ST-segment depression.
IV nitroglycerin and heparin were initiated, which significantly improved his pain and resolved the ST-segment.
CASE STUDY: DEFINITY® in the INPATIENT SETTING
84-year-old woman
Patient was admitted to the hospital for congestive heart failure. She presented with chest and abdominal pain, progressive dyspnea, and nausea for 3 days.
CASE STUDY: DEFINITY® in the Outpatient SETTING
46-year-old woman
46-year-old woman with a history of hypertrophic cardiomyopathy, with poor cardiology follow up. Presented with progressively worsening symptoms of congestive heart failure: dyspnea, lower extremity edema, palpitations.
An echocardiogram was performed to evaluate left ventricular wall motion status post an acute myocardial infarction.
Apical 4-chamber
See in High DEF(INITY)® DEF(INITY)®
Unenhanced
Unenhanced
See in High DEF(INITY)™
DEF(INITY)™
Apical 2-chamber
DEFINITY®
Unenhanced
Unenhanced Echo
- Hypokinetic left ventricular segments with suspected thrombus in the apex with a high concern for embolic risk
DEFINITY® Echo
- Hypokinetic left ventricular segments with severely decreased systolic function
- A large, bulbous, solid, partially fixed thrombus in the apex of the scarred, thinned, and akinetic left ventricle was identified
- A well-defined space was confirmed by the microbubbles separating a large area of thrombus from the apex, revealing a very high risk of embolism
See in High DEF(INITY)™
CK-MB=creatine kinase muscle and brain.
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An echocardiogram was performed to evaluate left ventricular wall motion, status post an acute myocardial infarction.
Conclusion
- The patient was started on systemic anticoagulation with intravenous heparin and medical therapy initiated for congestive heart failure
- Neurologic symptoms with the presence of a left ventricular thrombus confirmed the need for a brain MRI for assessment of stroke
- Cardiomyopathy confirmed the need for ischemic evaluation
- Surgical consultation was initiated for possible thrombolytic therapy vs surgical embolectomy
DEFINITY® in the critically ill enhanced overall efficiency, diagnostic accuracy, and cost-effective patient management1
CK-MB=creatine kinase muscle and brain.
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An echocardiogram was performed STAT for assessment of acute chest pain.
Apical 4-chamber
DEFINITY®
Unenhanced
Unenhanced
See in High DEF(INITY)™
Apical 2-chamber
DEFINITY®
Unenhanced
Unenhanced
See in High DEF(INITY)™
Apical Long Axis
DEFINITY®
Unenhanced
Unenhanced Echo
- Questionable wall motion abnormality in the inferolateral segment
DEFINITY® Echo
- Mid anterolateral, apical lateral and anterior wall motion abnormalities identified
- Mid-to-distal inferolateral wall motion confirmed
See in High DEF(INITY)™
LAD=left anterior descending; PDA=posterior descending artery; PLV=posterolateral vessel; RCA=right coronary artery.
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case study to share?
An echocardiogram was performed STAT for assessment of acute chest pain.
Conclusion
- Proceeded with an invasive angiogram
- With DEFINITY®, a timely and critical diagnosis was made providing the confidence that an invasive procedure was necessary, avoiding further testing and delay of treatment
Cardiac catheterization
- Significant 2-vessel coronary artery disease with 50% proximal stenosis of the LAD, 80-90% mid vessel stenosis of the RCA followed by 99% stenosis involving the bifurcation of the PDA and PLV
DEFINITY® in the emergent care setting delivered a diagnostic advantage for improved patient management1,2
LAD=left anterior descending; PDA=posterior descending artery; PLV=posterolateral vessel; RCA=right coronary artery.
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An echocardiogram was performed to assess left ventricular function and to identify the source of the chest pain.
Apical 4-chamber
DEFINITY®
Unenhanced
Unenhanced
See in High DEF(INITY)™
Apical 2-chamber
DEFINITY®
Unenhanced
Unenhanced
See in High DEF(INITY)™
Apical Long Axis
DEFINITY®
Unenhanced
Unenhanced Echo
- Unusual echogenic area within the apex protruding into the left ventricle
- Ill-determined true nature of an apical abnormality
DEFINITY® Echo
- Left ventricular opacification with DEFINITY® demonstrated a positive fill of microbubbles within the large space of the occupying lesion, confirming the presence of a mass and ruling out the likelihood of a thrombus
See in High DEF(INITY)™
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An echocardiogram was performed to assess left ventricular function and to identify the source of the chest pain.
Conclusion
- Metastatic cardiac tumor identified
- Started on anticoagulation and rivaroxaban
- Further diagnostic testing was avoided, allowing for an immediate referral to oncology
DEFINITY® allows bedside cardiac assessment and timely diagnosis for cost-effective patient management in hospitalized patients1
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An echocardiogram was performed for congestive heart failure.
Apical 4-chamber
DEFINITY®
Unenhanced
Unenhanced
See in High DEF(INITY)™
Apical 2-chamber
DEFINITY®
Unenhanced
Unenhanced
See in High DEF(INITY)™
Parasternal Long
DEFINITY®
Unenhanced
Unenhanced
See in High DEF(INITY)™
Parasternal Short
DEFINITY®
Unenhanced
Unenhanced
See in High DEF(INITY)™
Apical Long Axis
DEFINITY®
Unenhanced
Unenhanced Echo
- Prominent left ventricular hypertrophy with hyperdynamic left ventricular function
- Asymmetric basal septal hypertrophy with systolic anterior motion of the anterior mitral valve leaflet and small pericardial effusion
DEFINITY® Echo
- Prominent septal left ventricular hypertrophy with hyperdynamic left ventricular function
- Normal lateral wall thickness compared to the unenhanced image
- Prominent basal septal hypertrophy is evident in the parasternal long axis view
- Short axis sweep reveals the geometry of hypertrophic cardiomyopathy, demonstrating a counter-clockwise rotation from the basal anterior wall to the distal inferoapical segment
See in High DEF(INITY)™
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case study to share?
An echocardiogram was performed for congestive heart failure.
Conclusion
- Rare variant of spiral hypertrophic cardiomyopathy identified
- The patient was started on guideline-directed medical therapy to decrease left ventricular contractility and the outflow tract gradient
- An implantable cardioverter-defibrillator was placed due to risk for sudden cardiac death
DEFINITY® helped identify a rare variant of spiral
hypertrophic cardiomyopathy
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References:
-
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.
-
Mulvagh SL, Rakowski H, Vannan MA, et al. American society of echocardiography consensus statement on the clinical applications of ultrasonic contrast agents in echocardiography. J Am Soc Echocardiogr. 2008;21(11):1179-1281.
INDICATIONS
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.
IMPORTANT SAFETY INFORMATION
WARNING: SERIOUS CARDIOPULMONARY REACTIONS
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)].
References:
- 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.
- Mulvagh SL, Rakowski H, Vannan MA, et al. American society of echocardiography consensus statement on the clinical applications of ultrasonic contrast agents in echocardiography. J Am Soc Echocardiogr. 2008;21(11):1179-1281.
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