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Event Rates for Commonly Performed Cardiovascular Procedures Procedure Event Rate Event Coronary Angiography 1:1000 Death Exercise Treadmill Testing 1:2500 MI or Death SPECT Exam or Radionuclide Ventriculography 1:1000 to 1:10,000 Fatal Malignancy Contrast Echocardiography 1:500,000 Death Complete List of Contraindications to Ultrasound Contrast Agents Right-to-left, bi-directional, or transient right-to-left cardiac shunts Worsening or clinically unstable heart failure Acute myocardial infarction or acute coronary syndromes Serious ventricular arrhythmias or high risk for arrhythmias due to prolongation of the QT interval Respiratory failure, as manifest by signs or symptoms of carbon dioxide retention or hypoxemia Severe emphysema, pulmonary emboli or other conditions that cause pulmonary hypertension due to compromised pulmonary arterial vasculature Hypersensitivity to perflutren Complete List of Absolute Contraindications to Cardiac Catheterization “The only absolute contraindication to cardiac catherization is refusal of a mentally competent patient to consent to the procedure” Grossman W. Current practice standards. In: Baim DS and Grossman W, editors. Cardiac Catheterization, Angiography and Intervention. Baltimore, MD: Williams and Wilkins, 1996:9-16 Pseudocomplication Complications occurring after any medical pocedure may be attributable to the procedure itself progression of underlying disease state (pseudocomplication) Pseudocomplication Event -24 hour to cath Cath +72 hour SAE 0.81% 0.81% Death 0.24% 0% Hildner et al. Pseudocomplications of cardiac catherization. Chest 1973;63:15-17 Serious adverse events are relatively common in patients who are “sick enough” to warrant invasive testing ACC/AHA/ASE 2003 Guidelines Update for the Clinical Application of Echocardiography ACC/AHA/ASE 2003 Guidelines Update for the Clinical Application of Echocardiography Contrast Echocardiography is Superior to Tissue Harmonics for Assessment of Left Ventricular Function in Mechanically Ventilated Patients % 90 80 70 60 50 40 30 20 10 0 Conversion of non-diagnostic to diagnostic study Harmonics Kornbluth et al. Am Heart J 2000;140:291-6 Contrast Contrast Echocardiography is Superior to Tissue Harmonics for Assessment of Left Ventricular Function in Mechanically Ventilated Patients % 100 90 80 70 60 50 40 30 20 10 0 Wall motion scoring possible 1/5 of mechanically ventilated patients will require TEE if contrast contraindicated Fundamental Harmonics Kornbluth et al. Am Heart J 2000;140:291-6 Contrast Contrast Echocardiography Clarifies Uniterpretable Wall Motion in Intensive Care Unit Patients 25 20 % of patients with uniterpretable left ventricular function 15 % 10 5 0 Fundamental Harmonic Reilly JP et al. J Am Coll Cardiol 2000;35:485-90 Contrast Diagnostic Accuracy and Cost-Effectiveness of Contrast Echocardiography on Evaluation of Cardiac Function in Technically Very Difficult Patients in the Intensive Care Unit 100 90 80 70 60 50 40 30 20 10 0 Excellent or Adequate Endocardial Visualization % Fundamental Harmonic Contrast Yong et al. Am J Cardiol 2002;89:711-718 TEE Complications of Transesophageal Echocardiography Seward JB et al. J Am Soc Echocardiogr 1992;5:228 Complications of Transesophageal Echocardiography Daniel WG et al. Circulation 1991;83:17-821