title: [Usefulness and limitations of contrast echocardiography during dobutamine stress test].
abstract: BACKGROUND
  The aim of this study was to evaluate whether the use of contrast agent in addition to second harmonic imaging during dobutamine stress echocardiography can improve endocardial visualization and interobserver agreement in the evaluation of regional wall motion in patients with suboptimal or poor acoustic window.
  
  
  METHODS
  Twenty-one patients with a poor or suboptimal acoustic window underwent dobutamine stress echocardiography. Echocardiographic images in parasternal long-axis and short-axis, apical 4-chamber and 2-chamber views were cine-looped at baseline and peak stress before and after injection of contrast medium (Levovist at a concentration of 400 mg/ml). Endocardial visualization and regional wall motion were evaluated by two blinded observers.
  
  
  RESULTS
  The contrast medium improved segment visualization both at baseline (complete visualization in 74% of segments with contrast vs 71% without, p = NS) and at peak stress (76 vs 64%, p < 0.001). Contrast medium improved significantly segment visualization in apical 4-chamber view both at baseline (complete visualization in 87% of segments with contrast vs 72% without, p < 0.01) and at peak (89 vs 66%, p < 0.001) and in apical 2-chamber view both at baseline (81 vs 61%, p < 0.001) and at peak (89 vs 55%, p < 0.001). When individual segments were analyzed, endocardial visualization improved significantly in all segments of the anterior wall and in the mid and distal segments of the lateral wall both at baseline and at peak stress. The use of contrast medium did not improve significantly interobserver agreement in the evaluation of regional wall motion at peak stress (k = 0.63 vs 0.67 without and with contrast, respectively).
  
  
  CONCLUSIONS
  The use of Levovist during dobutamine stress echocardiography improves significantly segment visualization in the apical views both at baseline and at peak stress and increases interobserver agreement in the evaluation of regional wall motion at peak stress.
authors.affiliation: Dipartimento di Cardiologia IRCCS Policlinico San Matteo Piazzale Golgi, 2 27100 Pavia. ale.nit@libero.it
authors.forename: Alessandra
authors.initials: A
authors.lastname: Fontana
authors.forename: Elena
authors.initials: E
authors.lastname: Lucca
authors.forename: Nedy
authors.initials: N
authors.lastname: Brambilla
authors.forename: Luca
authors.initials: L
authors.lastname: Lanzarini
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.forename: Mario
authors.initials: M
authors.lastname: Previtali
mesh_terms: D002316:Cardiotonic Agents; D003287:Contrast Media / Q000008:administration & dosage; D004280:Dobutamine / Q000008:administration & dosage; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D015588:Observer Variation; D011134:Polysaccharides
chemical_list: D002316:Cardiotonic Agents; D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508; D004280:Dobutamine