Use of Ultrasound Enhancing Agents in Echocardiography for Stroke Across Yale New Haven Health System

Document Type

Article

Publication Title

Circulation

Abstract

Background: Transthoracic echocardiography (TTE) is routinely performed for evaluation of stroke. We examined patterns of ultrasound enhancing agent (UEA) use for stroke across Yale New Haven Health System (YNHHS) Hypothesis: Prevalence of left ventricular (LV) thrombus depends on LV function, wall motion and UEA use. Methods: 15209 TTE studies with indication of cerebrovascular accident or transient ischemic attack were performed from January 2019 to December 2022 across YNHHS. UEA was used in 7578 studies (49.8%). We compared the prevalence of LV thrombus and frequency of UEA use stratified by location (community hospitals, university hospitals, and outpatient sites) and by LV function. Chi square was used to compare rates of LV thrombus as well as frequency of UEA use stratified by LV function and location. Results: UEA use varied from 2.6% in community outpatient sites, 23.3 % in community hospitals to 77% in a university hospital. LV thrombus was detected in 56 of 7578 UEA studies (0.74%). Increasing prevalence of LV thrombus was associated with decreasing LV function (p<0.0001). LV thrombus was detected only in 1/3716 UEA studies (0.027%) with normal LV function and normal wall motion. Increased frequency of contrast use in university hospital compared with community hospitals did not lead to overall higher rate of thrombus detection.When stratified by LV function, only subgroup with normal function had marginally higher rate of LV thrombus, but prevalence of LV thrombus in this subgroup was very low. Conclusion: Significant variability of UEA in TTE exists for evaluation of stroke across YNHHS with low prevalence of thrombus in hyperdynamic to normal LV function without wall motion abnormalities. Increased use of UEA was not associated with increased rate of LV thrombus detection, except group with normal function. Value of increased detection in this group with low prevalence of thrombus should be balanced against cost and risk of adverse reactions.

DOI

https://doi.org/10.1161/circ.148.suppl_1.1650

Publication Date

11-6-2026

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