title: Clinical benefits of using second generation ultrasound contrast agents in stress echocardiography.
abstract: Stress echocardiography is an established and widely used method for the noninvasive detection of myocardial ischemia. However, despite introduction of new echocardiographic technologies, such as harmonic imaging, unsatisfactory image quality limits an accurate interpretation of left ventricular (LV) wall thickening and motion in up to 30% of patients during stress echocardiography. Development and availability of second generation transpulmonary contrast agents, which opacify the LV chamber and have the capability of enhancing endocardial border definition, facilitate high-quality imaging of LV structures even in technically difficult patients. Application of a contrast agent is not associated with significant extra cost of time and manipulations because bolus injections are sufficient in most instances and harmonic imaging capabilities as well as contrast specific presets are implemented and, thus, readily available in most modern ultrasound systems. Numerous studies have demonstrated that contrast echocardiography substantially improves LV cavity visualization at rest as well as at peak stress and, therefore, increases reader confidence and decreases interobserver variability. Moreover, enhanced learning curves for interpreting stress echocardiograms have been reported in novice readers. It has been reported that compared with native stress echocardiography the use of contrast results in identification of more true positive as well as true negative results and helps to avoid unnecessary invasive procedures in a considerable number of patients. Contrast stress echocardiography may, therefore, also prove cost effective in the future. Further refinements of contrast agent properties and new developments in imaging technology will likely continue to extend the spectrum of diagnostic cardiac imaging techniques and further enhance noninvasive assessment of the complex pathophysiology of coronary artery disease.
authors.affiliation: Department of Cardiology, Medizinische Poliklinik, University of Wuerzburg, Wuerzburg, Germany. p.jung@medizin.uni-wuerzburg.de
authors.forename: Philip H
authors.initials: PH
authors.lastname: Jung
authors.forename: C E
authors.initials: CE
authors.lastname: Angermann
mesh_terms: D000418:Albumins; D002983:Clinical Competence; D002986:Clinical Trials as Topic; D003287:Contrast Media; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D003362:Cost-Benefit Analysis; D025401:Echocardiography, Stress / Q000379:methods* / Q000592:standards; D005466:Fluorocarbons; D006801:Humans; D010743:Phospholipids; D013459:Sulfur Hexafluoride
chemical_list: D000418:Albumins; D003287:Contrast Media; C099458:FS 069; D005466:Fluorocarbons; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride