Current indications for contrast echocardiography imaging

The assessment of regional ventricular function is dependent on good endocardial definition. Suboptimal images can be converted to diagnostic recordings in the majority of patients by contrast agents, which have become an indispensable aid in rest and stress echocardiography. In particular for stress echocardiography image quality is essential and contrast administration is of great importance. However this diagnostic procedure must be performed following the indications which reflect the risks of the procedure and consider the benefits of an accurate diagnosis on further patient management. The contraindications recently introduced in the use of the echo-contrast agent SonoVue for acute cardiac patients reflect the same contraindications which have been applied in stress echocardiography for several years. Clinical trials and post-marketing surveillance have demonstrated that this approach is safe with no fatalities reported. For all ultrasound contrast media, side effects have been reported but they are usually mild. However, rare allergic and potentially life threatening reactions may occur and the investigators have to be prepared for such an event with appropriate drugs stored in the echo department. In a recent retrospective analysis in 751 consecutive stress echocardiograms the use of contrast during dobutamine stress echocardiography was not associated with an increased risk of side effects. The incidence of side effects was very low and different in patients receiving Optison, SonoVue or without contrast agent.

Ultrasound contrast agents are licensed for improvement of endocardial border definition. Data from clinical trials and wide clinical experience indicate an excellent risk/benefit ratio if the current contraindications are applied.