Contrast Echocardiography: Introduction
Conventional echocardiography is widely used and well documented in the evaluation of patients with stable and unstable coronary artery disease. In particular, assessment of left ventricular function, volumes, and ejection fraction adds important prognostic information in individual patients. In addition, echocardiography may detect any concomitant valvular heart disease as well as acute complications in unstable coronary syndromes. Stress echocardiography has through several studies established its role in the diagnosis of stable coronary artery disease and assessment of myocardial viability.
Methodology of Contrast Echocardiography
Contrast echocardiography has several advantages compared to other non-invasive imaging techniques like cardiac magnetic resonance imaging and cardiac computer tomography. First, it can be performed without the radiation exposure of computer tomography and without the potential nephrotoxisity of the gadolinium contrast agent necessary to assess myocardial perfusion by magnetic resonance imaging. Second, it can be performed bed-side and give immediate answers to important clinical questions in management of patients with known or suspected coronary artery disease. Contrast echocardiography requires intravenous administration of a second or third generation ultrasound contrast agent during contrast specific ultrasound imaging.


Conclusion
- Contrast echocardiography allows simultaneous assessment of regional myocardial function and perfusion, improving non-invasive diagnosis and assessment of coronary artery disease. Contrast echocardiography gives information on the physiological impact of the coronary artery stenosis, reveals the ischemic burden, detects viable myocardium and may act as a supplemental tool to coronary angiography in management of coronary artery disease and in follow-up after treatment. In addition, the ability to diagnose myocardial ischemia in patients with no-reflow phenomenon or microvascular disease and angiographically normal coronary arteries may help distinguishing patients with non-obstructive ischemic coronary artery disease from patients with non-cardiac chest pain. Future studies using targeted contrast microbubbles against specific disease processes may further improve diagnosis in ischemic coronary artery disease, and on-going studies explore the use of ultrasound contrast agents to potentiate the effect of thrombolysis in acute coronary artery occlusions.