The Role of Echocardiographic Contrast (Optison) in Enhancing Tricuspid Regurgitation Spectral Doppler Signals

In the United States, pulmonary hypertension (PHT) is an increasingly recognized cause of
morbidity and mortality.

Echocardiography, due to its widespread use, versatility, portability, noninvasive nature,
and safety, is routinely used as the primary method for diagnosis and evaluation of these
patients. However, in this very cohort, its accuracy is frequently compromised by poor
acoustic windows. The use of echocardiographic contrast (EC) in such patients may increase
diagnostic accuracy, eliminate the need for performing more invasive, time-consuming, and
expensive tests, and eliminate potential diagnostic and management errors.

Pulmonary Artery Systolic Pressure (PASP) is routinely measured noninvasively with
transthoracic echocardiography (TTE) by obtaining the tricuspid regurgitant velocity (TRV)
with continuous wave spectral Doppler and applying the modified Bernoulli equation.

The investigators aim to use the FDA approved perflutren-based EC agent Optison to augment
inadequate TR CW spectral Doppler envelopes and determine if the TRV and PASP measurements
obtained with the use of Optison correlate better with the invasive measurements obtained
simultaneously during right heart catheterization as opposed to those measurements obtained
without the use of EC.

Inclusion Criteria:

- consecutive patients (age ≥ 18 years old) undergoing right heart catheterization
catheterization laboratory for various clinical indications as part of routine
medical care;

- only patients with poor acoustic windows will be included (based on previous studies,
body habitus);

Exclusion Criteria:

- atrial fibrillation or other irregular rhythms (bigeminy, frequent ectopy)

- pregnant women

- known allergy to perflutren, blood products, albumin

- patients who cannot receive blood products due to religious beliefs

- evidence of intracardiac right to left shunting