title: Shu 508 A (Levovist)-enhanced Doppler echocardiography improves the assessment of valvular heart disease.
abstract: OBJECTIVE
  To investigate whether intravenous injection of SHU 508 A improves the diagnostic accuracy of Doppler echocardiography in the assessment of valvular pathologies.
  
  
  RESULTS
  One hundred and twenty-five consecutive patients with valvular pathology (aortic stenosis, n = 48; aortic regurgitation, n = 20; mitral stenosis, n = 21; and mitral regurgitation, n = 36) and diagnostically insufficient Doppler signal were enrolled in this multicenter study. The severity of valvular pathology was graded on a four-point scale using unenhanced and contrast-enhanced Doppler echocardiography as well as cardiac catheterization. Agreement with cardiac catheterization findings increased from 63% using the unenhanced examination to 73% using the contrast-enhanced Doppler examination. Grading was possible in all patients using SHU 508 A, whereas the unenhanced Doppler examination remained inconclusive in six patients. The weighted kappa coefficient between contrast-enhanced Doppler and cardiac catheterization for all diagnoses was 0.76 as compared to 0.68 between unenhanced Doppler and cardiac catheterization. Agreement was especially improved in aortic stenosis (kappa 0.69 unenhanced vs 0.81 contrast-enhanced) and in aortic regurgitation (kappa 0.45 unenhanced vs 0.75 contrast-enhanced). Patients with mitral stenosis and mitral regurgitation experienced less improvement.
  
  
  CONCLUSIONS
  In case of an inconclusive unenhanced Doppler echo study, the administration of a left heart contrast agent should be considered. SHU 508 A is especially useful in improving the severity grading of aortic stenosis and aortic regurgitation, while grading of mitral stenosis and mitral regurgitation is less improved.
authors.affiliation: Department of Cardiology, University Clinic RWTH Aachen, Germany. w/2m.virginia.edu
authors.forename: W
authors.initials: W
authors.lastname: Lepper
authors.forename: A
authors.initials: A
authors.lastname: Franke
authors.forename: H
authors.initials: H
authors.lastname: von Bibra
authors.forename: H
authors.initials: H
authors.lastname: Becher
authors.forename: K
authors.initials: K
authors.lastname: Holz
authors.forename: M
authors.initials: M
authors.lastname: Näbauer
authors.forename: Z
authors.initials: Z
authors.lastname: Vered
authors.forename: R
authors.initials: R
authors.lastname: Hoffmann
authors.forename: F A
authors.initials: FA
authors.lastname: Flachskampf
authors.forename: P
authors.initials: P
authors.lastname: Hanrath
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000379:methods; D003287:Contrast Media / Q000009:adverse effects; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D005858:Germany; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D007089:Image Enhancement; D007557:Israel; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides / Q000009:adverse effects; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508