Contrast for improving LV structural & functional assessment

Safety and efficacy of commercially available ultrasound contrast agents for rest and stress echocardiography a multicenter experience

Dolan MS, Gala SS, Dodla S, Abdelmoneim SS, Xie F, Cloutier D, Bierig M, Mulvagh SL, Porter TR, Labovitz AJ.

Comment:

A retrospective analysis of 42,408 patients who had baseline suboptimal images and/or underwent perfusion imaging and received contrast agents; 18,749 of these underwent stress echocardiography. Endocardial border visualization in patients with sub-optimal images given contrast resulted in comparable sensitivity (81% vs. 73%, p = NS) and diagnostic accuracy (82% vs. 77%, p = NS) for wall motion analysis compared with patients with optimal image quality. They concluded that contrast is a safe and useful diagnostic tool in the stress echocardiography laboratory.

Reference: J Am Coll Cardiol. 2009; 53(1); 32-8

A randomized cross-over study for evaluation of the effect of image optimization with contrast on the diagnostic accuracy of dobutamine echocardiography in coronary artery disease The OPTIMIZE Trial

Plana JC, Mikati IA, Dokainish H, Lakkis N, Abukhalil J, Davis R, Hetzell BC, Zoghbi WA.

Comment:

In a unique randomised trial setting, 101 patients referred for DSE agreed to have the test twice within a 24hour period – once with contrast and once without. The use of a contrast agent improved the percentage of segments adequately visualized at baseline (from 72 to 95%) and more so at peak stress (67 to 96%). Interpretation of wall motion with high confidence also increased with contrast agent use from 36% to 74%. The authors concluded that during dobutamine echocardiography, contrast agent administration improves endocardial visualization at rest and more so during stress, leading to a higher confidence of interpretation and greater accuracy in evaluating CAD.

Reference: JACC Cardiovasc Imaging. 2008 Mar; 1(2); 145-52

Analysis of regional left ventricular function by cineventriculography, cardiac magnetic resonance imaging, unenhanced and contrast-enhanced echocardiography

Hoffmann R, von Bardeleben S, Kasprzak J, Borges AC , ten Cate F, Firschke C, Lafitte S, Al-Saadi N, Kuntz-Hehner S, Horstick G, Greis C, Engelhardt M, Vanoverschelde JL & Becher H.

Comment:

56 patients had LV regional systolic function assessed using several imaging techniques. The best inter-observer agreement was found with contrast echocardiography (ĸ = 0.77) whereas it was significantly lower for ventriculography (ĸ = 0.56) and CMR (ĸ = 0.43). Accuracy to detect regional abnormalities, as defined by an expert panel, was highest for contrast echocardiography.

Reference: J Am Coll Cardiol (2006); 47(1); 121-28