Stress Echo Ultrasound Contrast in an Urban Safety Net Hospital to Refine Ischemia Evaluation

Exclusion Criteria

• •1. Documented medical history or discovery during screening and/or admission of any of the following:
• •* Severe aortic or mitral stenosis
• •* Significant resting left ventricular outflow tract obstruction (velocity \> 3 cm/s)
• •* Mobile left ventricular apical thrombus
• •* Acute pericarditis or pericardial tamponade
• •* Ascending or thoracic aortic aneurysm that is not stable or meets surgical criteria
• •* Acute decompensated congestive heart failure
• •* Established severe left ventricular systolic dysfunction (left ventricular ejection fraction \< 35%)
• •2. Definite acute coronary syndrome (e.g., unstable angina, acute myocardial infarction) as confirmed by elevated Troponin I (\>0.6 ng/L) on two successive measurements or ECG changes diagnostic for unstable angina (e.g. localized ST changes) in conjunction with clinical appraisal
• •3. Any of the following other abnormalities on the ECG at screening:
• •* Paced ventricular rhythm or complete left bundle branch block
• •* Uncontrolled arrhythmias defined by frequent premature ventricular complexes (PVCs) \> 10/minute, non-sustained ventricular tachycardia, or atrial fibrillation with rapid ventricular response
• •* 2nd or 3rd degree heart block
• •4. Uncontrolled hypertension defined as systolic blood pressure ≥ 200 mmHg and/or diastolic blood pressure ≥ 110 mmHg at screening
• •5. Hemoglobin (Hb) \< 7.5 mg/dL at screening or within 3 months prior to screening
• •6. Potassium \< 3.0 mmol/L or \> 5.5 mmol/L or severe electrolyte abnormality at screening that, in the opinion of the supervising physician or Investigator, makes stress testing unsafe
• •7. Females who are pregnant or nursing
• •8. Known intolerance to any of the study stress agents (dipyridamole, dobutamine) or study cardiac imaging agents (Optison, Cardiolite)
• •9. Weight ≥ 350lbs
• •10. Any physical or psychological condition that, in the opinion of the Investigator, may adversely affect the safety of the patient if enrolled in this trial.