A preliminary study on contrast characteristics and clinical application of bedside transthoracic contrast-enhanced ultrasound in iatrogenic cardiac tamponade.

BACKGROUND

Iatrogenic cardiac tamponade (ICT) is a life-threatening complication requiring rapid intervention. Although conventional echocardiography can aid in diagnosis, its ability to assess bleeding points is limited. Bedside contrast-enhanced ultrasound (CEUS) improves diagnostic accuracy by observing myocardial perfusion and active extravasation. This study evaluated the impact of CEUS on treatment strategies and clinical outcomes in patients with ICT.

METHODS

A retrospective analysis was conducted of 84 ICT patients, comparing a group that underwent CEUS-guided management (n=29) with a control group (n=55). Baseline characteristics, echocardiographic findings, treatment modalities, complications, and outcomes were analyzed. Furthermore, the study correlated specific CEUS imaging patterns with therapeutic decisions and patient prognosis.

RESULTS

The CEUS group had significantly lower surgical rates (17.2% vs. 40.0%, P=0.034), complications (17.2% vs. 52.7%, P=0.002), and mortality (3.5% vs. 12.7%, P=0.025). Quantitative analysis showed that perfusion parameters ascending slope (β), peak intensity (A), and A×β were significantly reduced at the lesion site compared to normal areas (all P<0.001), yet time to peak (TTP) was significantly prolonged (P=0.004). Receiver operating characteristic (ROC) curve analysis indicated that A×β and β possessed strong prognostic value for ICT, with areas under the curve (AUCs) of 0.754 (specificity of 95.65%) and 0.750 (optimal cutoff: 4.67 dB), respectively. Specific CEUS patterns effectively stratified patients; those with minimal active leakage were successfully managed conservatively, whereas patterns indicating severe injury reliably identified patients requiring surgical repair.

CONCLUSIONS

Bedside CEUS significantly optimizes the management of ICT by reducing unnecessary surgical procedures and improving survival rates. The technique provides critical, real-time insights that support individualized treatment strategies, demonstrating substantial value in emergency clinical decision-making.