Real-Time Myocardial Perfusion Echocardiography in the ICU
| Status: | Enrolling by invitation |
|---|---|
| Conditions: | Cardiology |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 2/7/2019 |
| Start Date: | September 22, 2017 |
| End Date: | August 1, 2019 |
(RTMPE in the ICU) The Impact of Real-Time Myocardial Perfusion Echocardiography on Diagnostic Confidence and Subsequent Management of Myocardial Ischemia in the Intensive Care Unit
This study is being done to find out if and how much the use of RTMPE improves a provider's
confidence in the diagnosis they assign. This is important because the use of RTMPE may
decrease the need for any additional invasive testing.
confidence in the diagnosis they assign. This is important because the use of RTMPE may
decrease the need for any additional invasive testing.
The finding of elevated troponins and regional wall motion abnormalities on echocardiography
in the absence of other signs of acute coronary syndrome among the intensive care population
creates a diagnostic challenge for evaluation. Sometimes these ill patients undergo invasive
coronary angiography to rule out acute thrombosis. Real-Time Myocardial Perfusion
Echocardiography (RTMPE) is a safe and accurate imaging modality to assess perfusion and can
be performed in the resting state at the bedside in the intensive care unit (ICU) to help
stratify the likelihood intracoronary thrombosis as the etiology for abnormal troponins
and/or echocardiography. The primary aim of this study is to evaluate the impact of RTMPE on
providers' diagnostic confidence using a 5-point Likert scale for patients that receive a
standard transthoracic echocardiogram (TTE) compared to patients that receive RTMPE. The
RTMPE to assess perfusion will be added to the standard transthoracic echocardiogram in
approximately 24 patients undergoing evaluation of myocardial ischemia in medical or surgical
ICUs. The caring provider will complete a web-based survey regarding their confidence in the
diagnosis prior to and after the study in both groups. The images will be interpreted by an
experienced cardiologist and results will be made available in the medical record. The
difference in diagnostic confidence scores will be analyzed using the Wilcoxon signed-rank
test. The secondary aims are to assess the management and outcomes in both groups.
in the absence of other signs of acute coronary syndrome among the intensive care population
creates a diagnostic challenge for evaluation. Sometimes these ill patients undergo invasive
coronary angiography to rule out acute thrombosis. Real-Time Myocardial Perfusion
Echocardiography (RTMPE) is a safe and accurate imaging modality to assess perfusion and can
be performed in the resting state at the bedside in the intensive care unit (ICU) to help
stratify the likelihood intracoronary thrombosis as the etiology for abnormal troponins
and/or echocardiography. The primary aim of this study is to evaluate the impact of RTMPE on
providers' diagnostic confidence using a 5-point Likert scale for patients that receive a
standard transthoracic echocardiogram (TTE) compared to patients that receive RTMPE. The
RTMPE to assess perfusion will be added to the standard transthoracic echocardiogram in
approximately 24 patients undergoing evaluation of myocardial ischemia in medical or surgical
ICUs. The caring provider will complete a web-based survey regarding their confidence in the
diagnosis prior to and after the study in both groups. The images will be interpreted by an
experienced cardiologist and results will be made available in the medical record. The
difference in diagnostic confidence scores will be analyzed using the Wilcoxon signed-rank
test. The secondary aims are to assess the management and outcomes in both groups.
Inclusion Criteria:
1. Adults age ≥ 18 years
2. Located in a designated ICU
3. TTE ordered by the primary care team
4. Significant delta in troponin trend
5. Concern for myocardial ischemia
6. Women of child-bearing potential must have a clinical negative pregnancy test result
7. Experienced sonographer available to complete RTMPE portion of the exam
8. Provider willing to complete the study survey
Exclusion Criteria:
1. Adults < 18 years
2. Contraindication to echo contrast administration
3. Location other than an ICU
4. No significant delta in troponin trend
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