Abstract
The currently available ultrasound-enhancing agents are approved for left ventricle opacification and Doppler enhancement. The current recommendation for stress echo is mainly focused on contrast enhancement of endocardial contour for analysis of regional wall motion abnormalities and left ventricular volumes, although a possible application is also in the enhancement of pulsed wave Doppler signal for left anterior descending flow detection in 5% of patients without readable signal at rest. Regarding the most attractive application of perfusion imaging, despite its tremendous proven potential, perfusion imaging with real-time myocardial contrast echocardiography is not a Food and Drug Administration-approved technique. Also, the European Medicine Agency did not approve ultrasound contrast agents for this specific application. As a result, real-time myocardial contrast echocardiography is seldom used. The key points of ultrasound-enhancing agents suggested utilization in stress echo have been summarized by the American Society of Echocardiography recommendations as follows: (1) whenever two or more contiguous segments cannot be visualized or a coronary artery territory cannot be completely visualized, (2) use of very low-dose bolus injections followed by slow saline flushes is optimal for reducing cavity shadowing, and (3) very low mechanical index pulse sequence schemes that detect nonlinear fundamental frequency responses at <0.2 mechanical indexes are recommended for optimal left ventricular opacification and reduced basal segment attenuation. Brief high mechanical index (>0.8) impulses (5–15 frames) can be used to clear the myocardium and improve endocardial border resolution. In the stress echo 2030 study network, a pragmatic approach is used. Contrast is used in its easiest single bolus administration both at rest and during stress, after standard acquisition without contrast, and such enhancement duration is sufficient for regional wall motion, left ventricular cavity, and coronary flow velocity assessment.
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Acknowledgments
The authors would like to acknowledge the contributions of Dr. Thomas Porter and Dr. Jeane Mike Tsutsui. They were the authors of sections of this chapter in the previous editions.
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Gaibazzi, N., Picano, E. (2023). Contrast Stress Echocardiography. In: Picano, E. (eds) Stress Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-031-31062-1_14
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