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Recommendations Endorsed for Contrast Agent Use in Cardiac Ultrasound Imaging

By MedImaging International staff writers
Posted on 25 Nov 2008

An American echocardiography society recently supported the use of contrast agents, used to enhance echocardiogram images, and provided a guide for physicians who may be hesitant to use the contrast agents following a 2007 U.S. Food and Drug administration (FDA) black box warning.

In a new statement, supported by expert consensus opinion, critical review, and evidence-based research, the American Society of Echocardiography (ASE; Morrisville, NC, USA; outlined why, when, and how the contrast agents should be used to enhance diagnosis, the role for each person in the lab, and methods to implement contrast in the lab. The statement, "The American Society of Echocardiography Consensus statement on the Clinical Applications of Ultrasonic Contrast Agents in Echocardiography," was published in the November 2008 issue of the Journal of the American Society of Echocardiography (JASE).

Cardiologists use echocardiograms (live, real-time ultrasound images of the beating heart) to evaluate the heart's performance, as well as the structures of the heart. The consensus statement confirmed that contrast enhancement is a fundamental part of modern, quality-driven echocardiography laboratories inside and outside the hospital where both resting and stress echo testing are performed.

"Ultrasound contrast agents have an established role in clinical diagnosis, patient management and clinical research," said Dr. Sharon Mulvagh, one of the lead authors of the document. "Contrast agents can provide sonographers and physicians the clear images they need to diagnose life-threatening heart conditions that may not be otherwise visible."

Acknowledging that the FDA black box warning initiated in 2007 and revised in 2008 may weigh heavily on concerned physicians, ASE outlined the proven benefits of contrast agents in its consensus statement, and reviewed the specific contraindications, which include significant intracardiac shunts, and known hypersensitivity. Beyond the obvious benefits of being able to clearly see heart structures in patients with poor images, most typically due to intervening fat and lung tissues, unique benefits include the following: (1) Contrast enhanced echocardiography in the emergency department can play a beneficial role in the triage of patients with chest pain through accurate, early diagnosis. (2) Contrast enhancement in technically difficult to image patients in the intensive care unit (ICU) can be used to provide bedside assessment of cardiac structure and function without having to resort to more invasive procedures (such as placing a probe into the esophagus and stomach). (3) The accuracy of contrast echocardiography has been validated for the qualitative and quantitative evaluation of the heart chambers, and should it be considered for patients in whom precise information is clinically required--such as patients under consideration for medical devices or potential heart transplant.

"Those in the medical field concerned about the safety of ultrasound contrast agents should consider the proven efficacy, the previously established safety of these compounds, and the potential risk of alternative procedures," said Dr. William A. Zoghbi, president of the American Society of Echocardiography. "Ultrasound contrast agents have been safely and effectively used in echocardiography studies performed in the echo lab, emergency department, ICU, interventional cardiology suite, and operating room."

ASE also noted that contrast agent use is cost-effective when used in an appropriate and efficient manner. Contrast echocardiography can convert a technically difficult, nondiagnostic stress echocardiogram into an accurate diagnostic study and avoid an unachievable, missed, or wrong diagnosis. This obviates the need for putting the patient through additional testing and improves efficiency, resulting in cost savings.

ASE advises the medical community that implementation of a contrast program requires a strong commitment to quality on the part of the medical director. Laboratories that have been successful in establishing contrast agent use have uniformly implemented a practice by which the sonographer, at the beginning of the study, identifies the need for the use of a contrast agent, on the basis of a standing order that clearly describes appropriate indications and addresses the relatively few contraindications.

The American Society of Echocardiography is a professional organization of physicians, cardiac sonographers, nurses, and scientists involved in echocardiography, the use of ultrasound to image the heart and cardiovascular system.

Related Links:
American Society of Echocardiography

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58 (62.227249145508): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

59 (!!!!! 3113.0313873291): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

60 (!!!!! 1199.9607086182): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

61 (!!!!! 2876.9969940186): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (909.09004211426): SELECT fid FROM jos_deeppockets WHERE id=294721187 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294721187 AND published='1' LIMIT 1

63 (524.04403686523): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=214 ORDER BY `ordering`

64 (!!!!! 1894.9508666992): select jos_twitters.link from jos_twitters where cat=10

65 (545.02487182617): select jos_facebook.link from jos_facebook where cat=10

66 (185.96649169922): select jos_google_plus.link from jos_google_plus where cat=10

67 (32.901763916016): select jos_linkedin.link from jos_linkedin where cat=10

68 (440.12069702148): SELECT fid FROM jos_deeppockets WHERE id=294721187 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294721187 AND published='1' LIMIT 1

69 (144.00482177734): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=214 ORDER BY `ordering`

70 (!!!!! 2364.1586303711): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294721187 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (263.21411132812): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294721187 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (!!!!! 1368.9994812012): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (53.167343139648): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (138.0443572998): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (333.07075500488): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (464.20097351074): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (144.95849609375): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (236.98806762695): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (585.07919311523): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (!!!!! 1720.9053039551): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (370.02563476562): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (312.08992004395): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (180.00602722168): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (443.93539428711): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294721187 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (715.01731872559): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294721187 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (127.07710266113): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (67.949295043945): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (228.8818359375): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (!!!!! 1023.0541229248): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (!!!!! 1759.0522766113): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (272.98927307129): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (362.87307739258): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (673.05564880371): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (216.00723266602): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (203.13262939453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

105 (!!!!! 4060.0299835205): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

106 (!!!!! 1883.0299377441): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294721187 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (663.04206848145): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294721187 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 1919.9848175049): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

109 (962.0189666748): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

110 (861.88316345215): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294721187 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (806.09321594238): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294721187 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 1233.1008911133): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (!!!!! 2750.8735656738): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (!!!!! 4545.9270477295): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

115 (825.88195800781): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

116 (732.8987121582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

117 (473.0224609375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

118 (532.15026855469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

119 (159.02519226074): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

120 (205.03997802734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

121 (107.0499420166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

122 (909.09004211426): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 134590.86418152): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (!!!!! 6718.8739776611): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294721187 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294721187 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 44135.093688965): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (!!!!! 9310.9607696533): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (!!!!! 7683.0387115479): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (394.10591125488): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (!!!!! 1389.0266418457): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (37.193298339844): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (737.90550231934): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (88.930130004883): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (597.00012207031): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (167.8466796875): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (446.08116149902): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (669.00253295898): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (255.82313537598): SELECT name FROM jos_deeppockets WHERE id=214

138 (34.809112548828): SELECT name FROM jos_deeppockets WHERE id=214

139 (905.03692626953): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (538.11073303223): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (!!!!! 1877.7847290039): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

142 (113.01040649414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

143 (!!!!! 20102.977752686): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 6530.0464630127): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294721187 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (!!!!! 4758.8348388672): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294721187 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 2053.0223846436): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (!!!!! 1274.1088867188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 2417.0875549316): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

149 (!!!!! 1457.9296112061): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

150 (!!!!! 5209.9227905273): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (!!!!! 1737.117767334): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

152 (!!!!! 5442.8577423096): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

153 (!!!!! 1566.8869018555): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294721187 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294721187 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (!!!!! 1098.1559753418): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=214 or channel_id is null)

155 (503.0632019043): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=214 or channel_id is null)

156 (643.01490783691): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 2079.0100097656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

158 (301.12266540527): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721187 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721187 AND published='1' LIMIT 1

159 (46.014785766602): select jos_twitters.link from jos_twitters where cat=10

160 (!!!!! 11040.925979614): select jos_facebook.link from jos_facebook where cat=10

161 (!!!!! 7925.9872436523): select jos_google_plus.link from jos_google_plus where cat=10

162 (!!!!! 5746.1261749268): select jos_linkedin.link from jos_linkedin where cat=10

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