title: Differing susceptibility of echocardiographic contrast agents to adverse effects of biologic factors: multicenter, videodensitometric comparison of octafluoropropane-filled microspheres with air-filled microspheres for left ventricular opacification.
abstract: BACKGROUND
  Echocardiographic contrast enhancement of the left ventricle has diagnostic value in the assessment of regional and global left ventricular (LV) function. The efficacy of both octafluoropropane-filled human albumin microbubbles (OCTA) and of air-filled human albumin microbubbles (AIR) for LV endocardial delineation and qualitative LV opacification has previously been reported. However, pulmonary disease, obesity, impaired LV function, and decreased echogenicity may diminish the efficacy of contrast agents for LV opacification. The purpose of this study was to compare the susceptibility of 2 contrast agents currently approved by the Food and Drug Administration to these biologic factors.
  
  
  METHODS
  To compare quantitative LV opacification with OCTA (0.2, 0. 5, 3.0, 5.0 mL) versus AIR (0.08 mL/kg, 0.22 mL/kg), we performed videodensitometry in 199 patients (average age 59.2 +/- 13.3 years, 79% men) studied in 2 identical, prospective, multicenter, blinded trials, of whom 74 had impaired LV function, pulmonary disease, or both, 70 were obese (body mass index >30 kg/m(2)), and 45 were nonechogenic (>/=4 of 6 endocardial segments were not seen in the apical 4-chamber view). Changes in videodensity from noncontrast to contrast agent with the same gain settings were determined at end diastole and end systole (gray scale 0 to 255 U) for 2 regions of interest: left ventricle apex-to-mid-cavity and mid-cavity-to-base. The relative influence of clinically evident pulmonary disease, impaired LV function on echocardiography, and echogenicity on LV opacification produced by both contrast agents was determined by multivariate analysis.
  
  
  RESULTS
  Significant videodensity increases ranging from 67% to 143% were observed with both agents. At the recommended initial doses (0.5 mL for OCTA, 0.22 mL/kg for AIR), OCTA produced greater opacification than AIR in both regions of interest and at both phases of the cardiac cycle. Poor LV function was associated with decreased LV opacification for AIR but not for OCTA. Diminished echogenicity was more strongly associated with impaired opacification for AIR than for OCTA. Obesity and clinically evident pulmonary disease were associated with diminished chamber opacification with both OCTA and AIR.
  
  
  CONCLUSIONS
  In addition to the superiority of octafluoropropane-filled microspheres to air-filled microspheres for LV opacification, the efficacy of OCTA is relatively unaffected by impaired LV function and is less susceptible to the effects of poor echogenicity than AIR.
authors.affiliation: Division of Cardiology and the Departments of Pharmacology and Biomathematics/Biostatistics, Georgetown University Hospital, Washington, DC.
authors.forename: E
authors.initials: E
authors.lastname: Hausnerova
authors.forename: J S
authors.initials: JS
authors.lastname: Gottdiener
authors.forename: J J
authors.initials: JJ
authors.lastname: Gould
authors.forename: J C
authors.initials: JC
authors.lastname: Pezzullo
authors.forename: J D
authors.initials: JD
authors.lastname: Callahan
authors.forename: J L
authors.initials: JL
authors.lastname: Cohen
authors.forename: D E
authors.initials: DE
authors.lastname: Bruns
authors.forename: M T
authors.initials: MT
authors.lastname: Kuvelas
authors.forename: H E
authors.initials: HE
authors.lastname: West
authors.forename: H C
authors.initials: HC
authors.lastname: Dittrich
mesh_terms: D000418:Albumins / Q000008:administration & dosage*; D000704:Analysis of Variance; D003287:Contrast Media / Q000008:administration & dosage*; D003720:Densitometry; D004452:Echocardiography; D005260:Female; D005466:Fluorocarbons / Q000008:administration & dosage; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007275:Injections, Intravenous; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D016037:Single-Blind Method; D016277:Ventricular Function, Left; D014743:Videotape Recording
chemical_list: D000418:Albumins; D003287:Contrast Media; D005466:Fluorocarbons