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. 2017 Sep 3:17:1-10.
doi: 10.1016/j.ijcha.2017.08.002. eCollection 2017 Dec.

Contrast microsphere enhancement of the tricuspid regurgitant spectral Doppler signal - Is it still necessary with contemporary scanners?

David G Platts  1   2   3 , Manan Vaishnav  2 , Darryl J Burstow  1   2   3 , Christian Hamilton Craig  1   2   3   4   5 , Jonathan Chan  1   2   6 , John L Sedgwick  1   2   3 , Gregory M Scalia  1   2   3   7
Affiliations

Contrast microsphere enhancement of the tricuspid regurgitant spectral Doppler signal - Is it still necessary with contemporary scanners?

David G Platts et al. Int J Cardiol Heart Vasc. .

Abstract

Background: Accurate evaluation of the tricuspid regurgitant (TR) spectral Doppler signal is important during transthoracic echocardiographic (TTE) evaluation for pulmonary hypertension (PHT). Contrast enhancement improves Doppler backscatter. However, its incremental benefit with contemporary scanners is less well established. The aim of this study was to assess whether the TR spectral Doppler signal using contemporary scanners was improved using a second generation contrast agent, Definity® (CE), compared to unenhanced TTE (UE).

Methods: Analysis of patients who underwent UE then CE TR interrogation was performed. TR signal was evaluated by an experienced reader and graded 1 (clear-high level of confidence of interpretation and complete spectral Doppler envelope), 2 (suboptimal with medium-low level of confidence of interpretation and incomplete envelope), 3 (poor-absent and no measurable spectral Doppler signal). Maximal TR velocity (TRV) was defined as peak velocity that could be clearly identified. An inexperienced sonographer read 30 randomly selected studies.

Results: 176 TTE were performed in 173 patients (mean age 57 ± 14.8 years). Wilcoxon signed rank test demonstrated significant improvement (p < 0.0001) in TR spectral Doppler signal quality with CE TTE. Mean score CE TTE vs. TTE = 2.32 ± 0.85 vs. 2.56 ± 0.75 respectively (p < 0.0001). Mean maximal TRV CE TTE vs. UE TTE = 2.61 ± 0.44 m/s vs. 2.54 ± 0.49 m/s respectively (p < 0.0001). The inexperienced reader had a greater improvement in scoring CE TTE signals vs. UE TTE (p < 0.0001).

Conclusion: In the era of contemporary scanners, CE improved the ability to detect and measure TRV, except in those with clear unenhanced TR spectral Doppler signals or greater than mild tricuspid regurgitation.

Keywords: Contrast echocardiography; Doppler echocardiography; Pulmonary hypertension; Tricuspid regurgitation.

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Figures

Fig. 1
Fig. 1
Spectral Doppler TR signal with contrast, before (A) and after (B) image optimisation. Note the reduction in spectral gain from a baseline of 50% to 5% and an increase in the filtering.
Fig. 2
Fig. 2
Absolute scores for TR spectral Doppler signal quality for unenhanced and contrast enhanced TTE.
Fig. 3
Fig. 3
Tricuspid regurgitant spectral Doppler signal profile with unenhanced (A) and contrast enhanced (B) TTE. Note the clear spectral envelope in both cases (but stronger with contrast) and the same maximal TR regurgitant velocities.
Fig. 4
Fig. 4
Tricuspid regurgitant spectral Doppler signal profile with unenhanced (A) and contrast enhanced (B) TTE. Note the better defined spectral envelope and higher velocity with contrast enhancement.
Fig. 5
Fig. 5
Tricuspid regurgitant spectral Doppler signal profile with unenhanced (A) and contrast enhanced (B) TTE. Note the incomplete, unmeasurable spectral Doppler envelope with unenhanced imaging and the clearly defined spectral envelope with a measurable maximal velocity following contrast administration.
Fig. 6
Fig. 6
Spectral Doppler signal with unenhanced TTE before (A) and after (B) optimisation of the envelope profile by altering the gain and filter settings. Note the better defined envelope and the clearer and slightly lower maximal velocity.
Fig. 7
Fig. 7
Tricuspid regurgitant spectral Doppler profile with agitated saline (A) and then with contrast enhancement (B). Note the cleaner, better defined envelope with contrast over agitated saline.
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