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(Circulation. 2005;112:1382-1383.)
© 2005 American Heart Association, Inc.

Editorial

Contrast Stress Echocardiography

Completing the Picture From Image Enhancement to Improved Accuracy and Prognostic Insight

Thomas H. Marwick, MBBS, PhD, FRACP

From the Department of Medicine, University of Queensland, Brisbane, Australia.

Correspondence to Prof T.H. Marwick, University of Queensland, Dept of Medicine, Princess Alexandra Hospital, Ipswich Road, Brisbane, Q4102, Australia. E-mail tmarwick@soms.uq.edu.au

Key Words: Editorials • contrast media • coronary disease • echocardiography

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Echocardiographic contrast agents have great value in combination with stress echocardiography. Their conventional role is to enhance left ventricular borders during suboptimal imaging, and the test is widely, if not universally, applied for this purpose.¹ The use of echocardiographic contrast agents unequivocally improves endocardial resolution,^2,3 facilitating concordant test interpretation,⁴ and there are probable diagnostic benefits,⁵ especially for less-expert readers. The evaluation of myocardial perfusion with echocardiographic contrast agents, long considered a holy grail of echocardiography, has become feasible as a result of improved understanding of microbubble–ultrasound interaction, equipment development, and significant efforts from a relatively small number of clinical investigators. The development of a feasible approach for myocardial contrast echocardiography has led to a number of recent reports that demonstrate improvement in the accuracy of stress echocardiography,^6,7 particularly for the identification of single-vessel disease, and the recognition of the true extent of coronary disease, a facet that is commonly underestimated with stress echocardiography.

See p 1444

The article by Tsutsui et al⁸ in this issue of Circulation represents another landmark in the clinical evaluation of myocardial contrast echocardiography. These investigators evaluated the prognostic value of myocardial perfusion imaging in 788 patients undergoing myocardial contrast echocardiography. The use of myocardial perfusion imaging significantly increased the proportion of studies recognized as abnormal, from 26% to 41%, with not only an increased recognition of ischemia but also a recognition of ischemia within areas thought to have infarction. As in previous literature, the extent of multivessel disease was better appreciated with contrast echocardiography. During . . . [Full Text of this Article]

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Prognostic Value of Dobutamine Stress Myocardial Contrast Perfusion Echocardiography

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Circulation 2005 112: 1444-1450. [Abstract] [Full Text]