From the Guidelines
Contrast echocardiography is a valuable diagnostic tool that can be used to enhance image quality and improve the assessment of left ventricular function, particularly in patients with suboptimal acoustic windows, and its use is recommended in specific clinical scenarios, as outlined in the European Association of Cardiovascular Imaging (EACVI) 2017 guidelines 1.
Options for Contrast Echocardiography
The options for contrast echocardiography include:
- Transthoracic echocardiogram (TTE) with contrast
- Transesophageal echocardiogram (TEE) with contrast
- Stress echocardiogram with contrast
- Contrast echocardiogram for assessment of left ventricular function and regional wall motion abnormalities
Clinical Scenarios for Contrast Echocardiography
Contrast echocardiography is recommended in the following clinical scenarios:
- Patients with suboptimal acoustic windows
- Patients with suspected left ventricular dysfunction
- Patients with suspected coronary artery disease
- Patients undergoing stress echocardiography
Administration of Contrast Agents
The administration of contrast agents should be performed by trained personnel, and the patient should be monitored for potential adverse events, as outlined in the EACVI 2017 guidelines 1.
Safety of Contrast Agents
The safety of contrast agents has been established in numerous studies, with a low incidence of adverse events, as reported in the EACVI 2017 guidelines 1.
Efficacy of Contrast Echocardiography
The efficacy of contrast echocardiography has been demonstrated in numerous studies, with improved assessment of left ventricular function and regional wall motion abnormalities, as reported in the EACVI 2017 guidelines 1.
From the FDA Drug Label
2 DOSAGE AND ADMINISTRATION
2.2 Recommended Dosage in Adult Patients Bolus Dosing The recommended bolus dose in adult patients is 10 microL/kg of activated DEFINITY administered intravenously over 30 to 60 seconds followed by a 10 mL flush of 0. 9% Sodium Chloride Injection, USP. Infusion Dosing The recommended infusion dose in adult patients is 1.3 mL of activated DEFINITY added to 50 mL of preservative-free 0. 9% Sodium Chloride Injection, USP administered intravenously.
The options for contrast echocardiography (echo-cardiogram) using perflutren (IV) are:
- Bolus Dosing: 10 microL/kg of activated DEFINITY administered intravenously over 30 to 60 seconds, with a maximum of two bolus doses
- Infusion Dosing: 1.3 mL of activated DEFINITY added to 50 mL of preservative-free 0.9% Sodium Chloride Injection, USP administered intravenously, with the infusion rate titrated as necessary to achieve optimal image enhancement 2
From the Research
Options for Contrast Echocardiography
The following options are available for contrast echocardiography:
- Definity and Optison are perflutren-based ultrasound contrast agents used in echocardiography 3
- Ultrasound contrast agents are approved for opacification of the heart chambers and to improve endocardial border definition 4
- Myocardial contrast enhancement is useful for assessing thickening of the myocardium and myocardial perfusion 4
- Contrast echocardiography can be used as an adjunctive technique when unenhanced echocardiography falls short in the differentiation of cardiac structural abnormalities such as cardiac masses 5
Clinical Applications of Contrast Echocardiography
Contrast echocardiography has several clinical applications, including:
- Assessment of left ventricular (LV) systolic function, especially when quantitative LV volumes and ejection fraction, or serial assessments are required 6
- Evaluation of the LV apex 6
- Evaluation of mechanical complications of myocardial infarction 6
- Evaluation of suspected intracardiac mass 6
- Enhancement of Doppler signals in the systemic circulation 6
- Assessment of myocardial viability 5
- Detection of coronary artery disease using myocardial perfusion imaging 5, 7
Benefits of Contrast Echocardiography
The benefits of contrast echocardiography include: