Ase Position PaperContrast Echocardiography: Current and Future Applications*
Section snippets
INTRODUCTION
New ultrasonographic (ultrasound) contrast agents and new imaging technologies to detect them have recently become available to the echocardiography laboratory. Intravenous (IV) injection of ultrasound contrast agents has been documented to improve endocardial border delineation.1 Contrast enhancement of the blood-tissue boundary enables improved assessment of ventricular wall motion, wall thickness and thickening, calculation of ejection fraction, and delineation of cardiovascular structural
Contrast Agents
The ability to opacify vascular structures with strong echoes (or “contrast”) on echocardiograms by injecting agitated saline solution or other fluids containing gas bubbles has been recognized for over 30 years.3 The primary mechanism by which injection of such fluids produces ultrasound contrast was determined to be increased backscatter from inclusions of microbubbles within the injectant. Such microbubbles markedly enhanced the blood echo by introducing multiple liquid-gas interfaces.
CONTRAST ECHOCARDIOGRAPHY: CURRENT INDICATIONS
In the United States and Europe, the Food and Drug Administration (FDA) and European Union, respectively, have approved several echocardiographic contrast agents for the indication of ventricular opacification and enhancement of endocardial border definition in patients with technically suboptimal echocardiograms. Left ventricular cavity opacification (LVO) is of clinical value for the assessment of cardiac structure and ventricular performance in resting and stress echocardiography. In
FUTURE APPLICATIONS
At present, the US FDA has approved 2 contrast agents (Albunex and Optison). Several additional agents have been approved in other countries. These agents have been approved only for the indication of ventricular cavity and endocardial border enhancement. A multitude of additional agents are under development and in various phases of the regulatory approval process (Table 1). Although clinically useful as endocardial border-enhancing agents, ultrasound contrast agents have the greater potential
TRAINING AND EXPERIENCE
The basic prerequisites for independent competence in echocardiography (Training Level 2) must be met before introduction of experience with contrast. Level 2 training is defined as including a minimum of 6 months of echocardiography education, involving 300 studies with a wide variety of abnormalities.96 Special competence in stress echocardiography training, as outlined by the American Society of Echocardiography, is also recommended.97 Cardiac sonographers should be well experienced and
SUMMARY AND RECOMMENDATIONS
Currently, the use of contrast echocardiography for the improvement of suboptimal rest and stress echocardiography by enhanced definition of the endocardial border is strongly validated. This enhanced definition has enabled improved assessment of cardiac structure and function, as well as diagnostic feasibility and accuracy. The combination of IV contrast with harmonic stress echocardiography is a powerful tool for improved wall motion analysis through enhanced image quality, routinely
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