Should contrast be routinely used for echocardiographic assessment of left ventricular function? A matter of appropriateness

Abstract

This editorial refers to ‘Assessment of systolic left ventricular function. A multi-centre comparison of cineventriculography, cardiac magnetic resonance imaging, unenhanced and contrast enhanced echocardiography’† by R. Hoffmann et al ., on page 607 Hoffmann et al. 1 present data showing that contrast-enhanced echocardiography, compared with unenhanced echocardiography, provides more accurate determination of left ventricular ejection fraction and significantly improves the correlation with cineventriculography and magnetic resonance imaging (MRI). Certainly, the most important question arising from this study is whether contrast injection should be routinely recommended for echocardiographic assessment of left ventricular function, as suggested by the study results. The authors did not discuss this question, nor did they state any clinical implications, thereby leaving the question open to public discussion. We would like to offer the following considerations. Because most heart diseases affect the left ventricle, assessment of left ventricular volumes and function is of critical importance. Several diagnostic approaches have proved their usefulness for assessing left ventricular function, including cineventriculography, echocardiography, MRI, and radionuclide angiography. However, providing quantitative estimates of left ventricular volume, all these approaches have their limitations, and their accuracy and feasibility have been the subject of countless studies. Of the four approaches mentioned, echocardiography has become the most widely used diagnostic technique for assessment of left ventricular function, because of its unrivalled … *Corresponding author. Tel: +49 201 723 4808; fax: +49 201 723 5408. E-mail address : thomas.buck{at}uni-essen.de