Contrast echocardiography: Putting things into perspective – a Canadian Cardiovascular Society/Canadian Society of Echocardiography joint commentary

Abstract

In a recently published Canadian Cardiovascular Society/Canadian Society of Echocardiography Position Paper on Contrast Echocardiography in Canada, we reviewed the clinical diagnostic utility of ultrasound contrast agents (UCAs) in echocardiography (1). These agents are approved in Canada for left ventricular (LV) opacifi-cation in suboptimal echocardiograms to enhance endocardial borders and ventricular chambers, and assess regional wall motion. Despite improvements in the quality of echocardiographic imaging, an estimated 5% to 10% of rest echocardiograms and 20% to 30% of stress echocardiograms remain suboptimal (2–4). The use of UCAs improves diagnostic accuracy and contributes to a cost-effective pattern of care (3). In previous clinical studies, UCAs have been shown to be safe and effective in numerous circumstances such as improving the accuracy of qualitative assessment of global LV systolic function as well as quantitative assessment of LV volumes and ejection fraction, improving the accuracy and interobserver agreement of LV regional wall motion evaluation, increasing the reproducibility and interobserver agreement in stress echocardiography interpretation, and helping to define specific anomalies (myocardial rupture, pseudoaneurysms, intracardiac thrombi, aortic dissection, LV noncompaction, apical hypertrophic cardiomyopathy, etc) (1). UCAs enhance Doppler signals and have been used during transesophageal echocardiography for left atrial appendage thrombus detection and assessment of aortic dissection (1).