Clinical benefits of contrast-enhanced echocardiography during rest and stress examinations

Despite the recent introduction of tissue harmonic imaging in echocardiography, 10-15% of patients have poor endocardial border definition. This may lead to erroneous assessment of regional and global left ventricular (LV) function or to further diagnostic imaging with another modality thus increasing the costs for the healthcare system. The recent development of second generation contrast echocardiography agents such as SonoVue has resulted in several studies showing the value of these agents to outline endocardium clearly, thereby improving assessment of LV function. The use of these contrast agents has also opened the possibility of automated and quantitative LV function assessment, making it more accurate and reproducible. Other major clinical uses of these contrast agents are evaluation of LV masses such as thrombus and tumors, and better definition of LV structure such as delineating LV aneurysm, pseudoaneurysm; and non-compaction of LV and apical cardiomyopathy. Furthermore, the use of these contrast agents during stress not only improved the assessment of wall motion but also made possible the evaluation of myocardial perfusion, thereby increasing diagnostic accuracy for the detection of coronary artery disease.