Advertisement

Contrast echocardiography: review and future directions

  • Shi-Chi Cheng
    Affiliations
    Section of Cardiology, Department of Internal Medicine, Rush-Presbyterian–St. Luke’s Medical Center and the University of Illinois at Chicago, Chicago, Illinois, USA
    Search for articles by this author
  • Timothy C. Dy
    Affiliations
    Section of Cardiology, Department of Internal Medicine, Rush-Presbyterian–St. Luke’s Medical Center and the University of Illinois at Chicago, Chicago, Illinois, USA
    Search for articles by this author
  • Steven B. Feinstein
    Correspondence
    Address for reprints: Steven B. Feinstein, MD, Room 1015 JELKE, Rush-Presbyterian–St. Luke’s Medical Center, 1653 West Congress Parkway, Chicago, Illinois 60612-3833
    Affiliations
    Section of Cardiology, Department of Internal Medicine, Rush-Presbyterian–St. Luke’s Medical Center and the University of Illinois at Chicago, Chicago, Illinois, USA
    Search for articles by this author

      Abstract

      Recent developments and advances in contrast echocardiography have been made to improve the diagnosis and evaluation of cardiac structures and function. By coupling new developments in acoustic instrumentation with new contrast agents, information that was previously difficult or impossible to gather by standard 2-dimensional echocardiography can now be obtained. Numerous studies have been published confirming the advantages of using contrast during echocardiographic studies, particularly with stress testing and myocardial perfusion. This review aims to summarize (1) the various contrast agents that are available or being developed; (2) factors that have been found to affect the strength of enhanced signals; (3) the new developments in instrumentation that improve the ability of scanners to differentiate echo contrast from cardiac tissue; and (4) the documented and possible future uses of contrast echocardiography.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gramiak R.
        • Shah P.M.
        Echocardiography of the aortic root.
        Invest Radiol. 1968; 3: 356-366
        • McKay R.S.
        • Rubissow G.
        Decompression studies using ultrasonic imaging of bubbles.
        IEEE Trans BME. 1978; 25: 2537-2544
        • Ziskin M.C.
        • Bonakdapour A.
        • Weinstein D.P.
        • Lynch P.R.
        Contrast agents for diagnostic ultrasound.
        Invest Radiol. 1972; 7: 500-505
        • Meltzer R.S.
        • Tickner E.G.
        • Sahines T.
        • Popp R.L.
        The source of ultrasound contrast effects.
        J Clin Ultrasound. 1980; 18: 121-127
        • Feigenbaum H.
        • Stone J.M.
        • Lee D.A.
        Identification of ultrasound echoes from the LV by the use of indocyanine green.
        Circulation. 1970; 41: 613-620
        • Grinstaff M.W.
        • Suslick K.
        An air-filled proteinaceous microbubble. Synthesis of a new echo-contrast agent.
        Proc Natl Acad Sci USA. 1990; 88: 7708-7710
        • Ophir J.
        • Parker K.J.
        Contrast agents in diagnostic ultrasound.
        Ultrasound Med Biol. 1989; 15: 319-333
        • Bommer W.J.
        • Shah P.M.
        • Allen H.
        • Meltzer R.
        • Kisslo J.
        The safety of contrast echocardiography.
        J Am Coll Cardiol. 1984; 3: 6-13
        • Feinstein S.B.
        • TenCate F.
        • Werner Z.
        • Ong K.
        • Maurer G.
        • Tei C.
        • Shah P.M.
        • Meerbaum S.
        • Corday E.
        Two-dimensional contrast echocardiography. I. In vitro development and quantitative analysis of echo contrast agents.
        J Am Coll Cardiol. 1984; 3: 14-20
        • Powsner S.
        • Wood J.
        • Prieto P.
        High speed interface for myocardial sonicated contrast studies.
        SPIE. 1989; 845 (Abstr.): 384
        • Kondo S.
        • Tei C.
        • Meerbaum S.
        • Corday E.
        • Shah P.M.
        Hyperemic response of intracoronary contrast agents during echocardiographic delineation of regional myocardium.
        J Am Coll Cardiol. 1984; 4: 149-156
        • Barnhart J.
        • Leven H.
        • Villapando E.
        Characteristics of Albunex.
        Invest Radiol. 1990; 25: S162-S164
        • Keller M.W.
        • Glahseen W.
        • Kaul S.
        Albunex.
        J Am Soc Echocardiogr. 1989; 2: 48-52
        • Feinstein S.B.
        • Cheirif J.
        • Ten Cate F.J.
        Safety and efficacy of a new transpulmonary ultrasound contrast agent.
        J Am Coll Cardiol. 1990; 16: 316-324
        • Porter T.
        • Xie F.
        • Kilzer K.
        Intravenous perfluoropropane-exposed sonicated dextrose albumin produces myocardial contrast which correlates with coronary blood flow.
        J Am Soc Echocardiogr. 1995; 8: 710-718
      1. Albers VM. Underwater Acoustic Handbook. Hershey, PA: Pennsylvania State University Press, 1960.

        • Quay S.C.
        Ultrasound contrast agent development.
        J Ultrasound Med. 1994; 13 (Abstr.): S9
        • Quay S.C.
        Microbubble-based ultrasound contrast agents.
        J Ultrasound Med. 1994; 13 (Abstr.): S9
        • Ten Cate F.J.
        • Aiazian A.
        • de Jong N.
        Advances in clinical contrast echocardiography.
        The Thoraxcentre J. 1995; 7: 13-14
        • Crouse L.
        • Cheirif J.
        • Hanley D.
        • Kisslo J.
        • Labovitz A.
        • Raichlen J.
        • Schutz R.
        • Shah P.
        • Smith M.
        Opacification and border delineation improvement in patients with suboptimal endocardial border definition in routine echocardiography.
        J Am Coll Cardiol. 1993; 22: 1494-1500
        • de Jong N.
        Basic principles of ultrasound contrast agents.
        in: de Jong N. Acoustic Properties of Ultrasound Contrast Agents. Zuidam and Zonen, Woerden, The Netherlands1993: 17-36
        • Heidenreich P.A.
        • Harper P.V.
        • Chen T.W.
        • Dick C.D.
        • Feinstein S.B.
        Contrast echo measurement of myocardial perfusion.
        Circulation. 1988; 4 (Abstr.): 566
        • Reisner S.A.
        • Shapiro J.R.
        • Amico A.F.
        • Meltzer R.S.
        Contrast agents for myocardial perfusion studies. Mechanisms, state of the art, and future prospects.
        in: Meerbaum S. Meltzer R. Myocardial Contrast Two-dimensional Echocardiography. Kluwer Academic, Dordrecht1989: 45-59
        • Feinstein S.B.
        • Voci P.
        • Segil L.J.
        • Harper P.V.
        Contrast echocardiography.
        in: Marcus M.L. Skorton D.J. Schelbert H.R. Wolf G.L. Cardiac Imaging A Companion to Braunwald’s Heart Disease. WB Saunders, Philadelphia1991: 557-574
        • Hamilton W.F.
        • Remington J.W.
        Comparison of the time concentration curves in arterial blood of diffusible and nondiffusible substances when injected at a constant rate and when injected instantaneously.
        Am J Physiol. 1947; 148: 35-39
        • Rovai D.
        • Lombardi M.
        • Ghelardini G.
        • Marzilli M.
        • Taddei L.
        • Michelassi C.
        • Distante A.
        • DeMaria A.N.
        • L’Abbate A.
        Discordance between responses of contrast echo intensity to increased flow rate in human coronary circulation and in vitro.
        Am Heart J. 1992; 124: 398-404
        • Walker R.
        • Wiencek J.G.
        • Aronson S.
        The influence of intravenous Albunex injection on pulmonary hemodynamics, gas exchange and left ventricular peak intensity.
        J Am Soc Echocardiogr. 1992; 5: 462-470
        • Powsner S.M.
        • Feinstein S.B.
        • Keller M.W.
        • Saniie J.
        Quantitation of echo-contrast effects.
        Am J Physiol Imaging. 1986; 1: 124-128
        • Rovai D.
        • DeMaria A.
        • L’Abbate A.
        Myocardial contrast echo effect.
        J Am Coll Cardiol. 1995; 26: 12-17
        • Rovai D.
        • Lombardi M.
        • Taddei L.
        • Mazzarisi A.
        • Landini L.
        • Ghelardini G.
        • Distante A.
        • Benassi A.
        • L’Abbate A.
        Flow quantitation by contrast echocardiography.
        Int J Card Imaging. 1993; 9: 21-27
      2. Winkelmann JW, Feinstein SB. Contrast echocardiography. In: St. John Sutton MG, Oldershaw PJ, Kotler MN, eds. Textbook of Echocardiography and Doppler in Adults and Children. 2nd ed. Oxford, UK: Blackwell Science, 1994:507–515.

        • Block R.J.
        • Brodsky L.
        • Ostoic T.
        • Fernandez A.
        • Hickle P.
        • Devries S.
        • Bieniarz T.
        • In M.
        • Feinstein S.B.
        Optimizing Albunex in the left ventricle.
        J Am Soc Echo. 1996; 9: 787-794
        • Wei K.
        • Skyba D.
        • Firshke C.
        • Jayaweera A.
        • Lindner J.
        • Kaul S.
        Interactions between microbubbles and ultrasound.
        J Am Coll Cardiol. 1997; 29: 1081-1088
        • Gandhok N.
        • Block R.
        • Ostoic T.
        • Rawal M.
        • Hickle P.
        • Devries S.
        • Feinstein S.B.
        Reduced forward output states affect the left ventricular opacification of intravenously administered Albunex.
        J Am Soc Echo. 1997; 10: 25-30
        • Burns P.N.
        • Powers J.E.
        • Simpson D.H.
        • Uhlendorf V.
        • Fritzsche T.
        Harmonic imaging.
        Clin Radiol. 1996; 51: 50-55
        • Schrope B.
        • Newhouse V.L.
        • Uhlendorf V.
        Simulated capillary blood flow measurement using a non-linear ultrasonic contrast agent.
        Ultrason Imaging. 1992; 14: 134-158
        • de Jong N.
        Background.
        in: de Jong N. Acoustic Properties of Ultrasound Contrast Agents. Zuidam and Zonen, Woerden, The Netherlands1993: 1-16
        • Porter T.M.
        • Xie F.
        Transient myocardial contrast after initial exposure to diagnostic ultrasound pressures with minute doses of intravenously injected microbubbles.
        Circulation. 1992; 92: 2391-2395
        • Marwick T.H.
        • Nemec J.J.
        • Pashkow F.J.
        • Stewart W.J.
        • Salcedo E.E.
        Accuracy and limitations of exercise echocardiography in a routine clinical setting.
        J Am Coll Cardiol. 1992; 19: 74-81
        • Yvorchuk K.J.
        • Sochowski R.A.
        • Chan K.L.
        Sonicated albumin in exercise echocardiography.
        J Am Soc Echo. 1996; 9: 462-469
        • Porter T.R.
        • Xie F.
        • Kricsfeld A.
        • Chiou A.
        • Dabestani A.
        Improved endocardial border resolution during dobutamine stress echocardiography with intravenous sonicated dextrose albumin.
        J Am Coll Cardiol. 1994; 23: 1440-1443
        • Voci P.
        • Testa G.
        • Feinstein S.B.
        Enhancement of endocardial border detection by intravenous contrast injection during stress echocardiography.
        Cardiovascular Imaging. 1996; 8: 285-287
        • Marcovitz P.
        • Armstrong W.
        Accuracy of dobutamine stress echocardiography in detecting coronary artery disease.
        Am J Cardiol. 1992; 69: 1269-1273
      3. Nihoyannopoulos P. Stress echo using ultrasound contrast agents. (Abstr.) Presented at the First Europe Symposium on Ultrasound Contrast Imaging. Rotterdam, The Netherlands. January 25–26, 1996.

        • Kemper A.J.
        • Force T.
        • Kloner R.
        Contrast echocardiographic estimation of regional myocardial blood flow after acute coronary occlusion.
        Circulation. 1985; 72: 1115-1124
        • Villanueva F.S.
        • Glasheen W.P.
        • Sklenar J.
        • Kaul S.
        Assessment of risk area during coronary occlusion and infarct size after reperfusion with myocardial contrast echocardiography using left and right atrial injections of contrast.
        Circulation. 1993; 88: 596-604
        • Ten Cate F.J.
        • Drury K.
        • Meerbaum S.
        • Noorsdy J.
        • Feinstein S.B.
        • Shah P.M.
        • Corday E.
        Myocardial contrast two-dimensional echocardiography.
        J Am Coll Cardiol. 1984; 3: 1219-1226
        • McKay R.G.
        • Pfeffer M.A.
        • Pastermak R.C.
        • Marikis J.E.
        • Come P.C.
        • Nakao S.
        • Alderman J.K.
        • Ferguson J.J.
        • Safian R.D.
        • Grossman W.
        Left ventricular remodeling after myocardial infarction.
        Circulation. 1986; 74: 693-702
        • Ito H.
        • Maruyama A.
        • Iwakura K.
        • Takiuchi S.
        • Minamino T.
        Clinical implications of the “no-reflow” phenomenon.
        Circulation. 1996; 93: 223-228
        • DeMaria A.N.
        • Bommer W.J.
        • Riggs K.
        • Mason D.T.
        Echocardiographic visualization of myocardial perfusion by left heart and intracoronary injection of echo contrast agent.
        Circulation. 1980; 62 (Abstr.): III-143
        • Tei C.
        • Sakamaki T.
        • Shah P.M.
        • Corday E.
        Myocardial contrast echocardiography.
        Circulation. 1983; 67: 585-593
        • Armstrong W.F.
        • West S.R.
        • Mueller T.M.
        • Dillon J.C.
        • Feigenbaum H.
        Assessment of location and size of myocardial infarction with contrast-enhanced echocardiography.
        J Am Coll Cardiol. 1983; 2: 63-69
        • Kaul S.
        • Pandian N.G.
        • Okada R.D.
        • Weiman A.E.
        Contrast echocardiography in acute myocardial ischemia: I. In vivo determination of total left ventricular “area at risk.”.
        J Am Coll Cardiol. 1984; 4: 1272-1282
        • Feinstein S.B.
        • Shah P.M.
        • Bing R.J.
        • Meerbaum S.
        • Corday E.
        • Chang B.L.
        • Santillan G.
        • Fujibayashi Y.
        Microbubble dynamics visualized in the intact capillary circulation.
        J Am Coll Cardiol. 1984; 4: 595-600
        • Cheirif J.
        • Yamamoto H.
        • Zoghbi W.A.
        • Quinones M.A.
        Demonstration of physiologic transit time of sonicated meglumine diatrizoate in a microvascular preparation.
        J Cardiovasc Ultrasound. 1987; 6: 245-247
        • Jayaweera A.R.
        • Edwards N.
        • Glasheen W.P.
        • Villanueva F.S.
        • Abbott R.D.
        • Kaul S.
        In vivo myocardial kinetics of air-filled albumin microbubbles during myocardial contrast echocardiography.
        Circ Res. 1994; 74: 1157-1165
        • Porter T.
        • Xie F.
        • Kricsfeld A.
        • Kilzer K.
        Noninvasive identification of acute myocardial ischemia and reperfusion with contrast ultrasound using intravenous perfluoropropane-exposed sonicated dextrose albumin.
        J Am Coll Cardiol. 1995; 26: 33-40
        • Mudra H.
        • Zwehl W.
        • Klauss V.
        • Haufe M.
        • Spes C.
        • Theisen K.
        Myocardial contrast echocardiography with sonicated ioprimide (Ultravist 370) before and after coronary angioplasty.
        Z Kardiol. 1991; 80: 367-372
        • Reisner S.A.
        • Ong L.S.
        • Lichtenberg G.S.
        • Shapiro J.
        • Amico A.
        • Allen M.
        • Meltzer R.
        Quantitative assessment of the immediate results of coronary angioplasty by myocardial contrast echocardiography.
        J Am Coll Cardiol. 1989; 13: 852-859
        • Jayaweera A.
        • Sklenar J.
        • Kaul S.
        Quantification of images obtained during myocardial contrast echocardiography.
        Echo. 1994; 11: 385-396
        • Kenner M.
        • Zajac E.
        • Kondos G.T.
        • Dave R.
        • Winkelmann J.W.
        • Joftus J.
        • Laucevicius A.
        • Kybarskis A.
        • Berukstis E.
        • Urbonas A.
        • Feinstein S.B.
        Ability of the no-reflow phenomenon during an acute myocardial infarction to predict left ventricular dysfunction at one-month follow-up.
        Am J Cardiol. 1995; 76: 861-868
        • Nanto S.
        • Lim Y.J.
        • Masuyama T.
        • Hori M.
        • Nagata S.
        Diagnostic performance of myocardial contrast echocardiography for detection of stunned myocardium.
        J Am Soc Echocardiogr. 1996; 9: 314-319
        • Camarano G.
        • Ragosta M.
        • Gimple L.
        • Powers E.R.
        • Kaul S.
        Identification of viable myocardium with contrast echocardiography in patients with poor left ventricular systolic function caused by recent or remote myocardial infarction.
        Am J Cardiol. 1995; 75: 215-219
        • Villanueva F.
        • Glasheen W.
        • Sklenar J.
        • Kaul S.
        Characterization of spatial patterns of flow within the reperfused myocardium by myocardial contrast echocardiography.
        Circulation. 1993; 88: 2596-2606
        • Widimsky P.
        • Cornel J.H.
        • Ten Cate F.J.
        Evaluation of collateral blood flow by myocardial contrast-enhanced echocardiography.
        Br Heart J. 1988; 59: 20-22
        • Ito H.
        • Tomooka T.
        • Sakai N.
        • Yu H.
        • Higashino Y.
        • Fujii D.
        • Masuyama T.
        • Ketabatake A.
        • Minamino T.
        Lack of myocardial perfusion immediately after successful thrombolysis.
        Circulation. 1992; 85: 1699-1705
        • Sabia P.
        • Powers E.
        • Jayaweera A.R.
        • Ragosta M.
        • Kaul S.
        Contrast echocardiographic mapping of collateralized myocardium in humans before and after coronary angioplasty.
        Circulation. 1990; 16: 1594-1600
        • Reisner S.A.
        • Ong L.S.
        • Fitzpatrick P.G.
        • Lichtenberg G.S.
        • Sullebarger J.T.
        • Allen M.N.
        • Meltzer R.S.
        Evaluation of coronary flow reserve using myocardial contrast echocardiography in humans.
        Eur Heart J. 1992; 13: 389-394
        • Goldman M.E.
        • Mindich B.P.
        Intraoperative cardioplegia contrast echocardiography for assessing myocardial perfusion during open heart surgery.
        J Am Coll Cardiol. 1984; 4: 1029-1034
        • Smith J.
        • Feinstein S.B.
        • Kapelanski D.P.
        • Karp R.
        • Roizen M.
        Transesophageal echocardiographic determination of myocardial perfusion during cardiac surgery.
        Circulation. 1986; 74 (Abstr.): 475
        • Aronson S.
        • Lee B.K.
        • Zaroff J.G.
        • Wiencek J.
        • Walker R.
        • Feinstein S.B.
        • Karp R.
        Myocardial distribution of retrograde delivered cardioplegia in patients undergoing cardiac surgery.
        J Thorac Cardiovasc Surg. 1993; 105: 214-221
        • Partington M.T.
        • Acar C.
        • Buckberg G.P.
        • Julia P.
        • Kofsky E.
        • Bugyi H.
        Studies of retrograde cardioplegia: I. Capillary blood flow distribution to myocardium supplied by open and occluded arteries.
        J Thorac Cardiovasc Surg. 1989; 97: 605-612
        • Meza M.
        • Kates M.
        • Barbee W.
        • Revall S.
        • Perry B.
        • Murgo J.P.
        • Cheirif J.
        Combination of dobutamine and myocardial contrast echocardiography to differentiate postischemic from infarcted myocardium.
        J Am Coll Cardiol. 1997; 29: 974-984
        • Bolognese L.
        • Antoniucci D.
        • Rovai D.
        • Buonamici P.
        • Cerisano G.
        • Santoro G.M.
        • Marini C.
        • L’Abbate A.
        • Fazzini P.F.
        Myocardial contrast echocardiography versus dobutamine echocardiography for predicting functional recovery after acute myocardial infarction treated with primary coronary angioplasty.
        J Am Coll Cardiol. 1996; 28: 1677-1683
        • von Bibra H.
        • Sutherland G.
        • Becher H.
        • Neudert J.
        • Nihoyannopoulos P.
        Clinical evaluation of left heart Doppler contrast enhancement by a saccharide-based transpulmonary contrast agent.
        J Am Coll Cardiol. 1995; 25: 500-508
        • von Bibra H.
        • Becher H.
        • Firschke C.
        • Schlief R.
        • Emslander H.P.
        • Schömig A.
        Enhancement of mitral regurgitation and normal left atrial color Doppler flow signals with peripheral venous injection of a saccharide-based contrast Agent.
        J Am Coll Cardiol. 1993; 22: 521-528
        • Terasawa A.
        • Miyatake K.
        • Nakatani S.
        • Yamagishi M.
        • Matsuda H.
        • Beppu S.
        Enhancement of Doppler flow signals in the left heart chambers by intravenous injection of sonicated albumin.
        J Am Coll Cardiol. 1993; 21: 737-742
        • Kemp Jr, W.E.
        • Kerins D.
        • Shyr Y.
        • Byrd III, B.F.
        Optimal Albunex dosing for enhancement of Doppler tricuspid regurgitation spectra.
        Am J Cardiol. 1997; 79: 232-234
        • Nakatani S.
        • Imanishi T.
        • Terasawa A.
        • Beppu S.
        • Nagata S.
        • Miyatake K.
        Clinical application of transpulmonary contrast-enhanced Doppler technique in the assessment of severity of aortic stenosis.
        J Am Coll Cardiol. 1992; 20: 973-978
        • Firschke C.
        • Lindner J.R.
        • Goodman N.C.
        • Skyba D.
        • Wei K.
        • Kaul S.
        Myocardial contrast echocardiography in acute myocardial infarction using aortic root injections of microbubbles in conjunction with harmonic imaging.
        J Am Coll Cardiol. 1997; 29: 207-216
        • Porter T.R.
        • Li S.
        • Kricsfeld D.
        • Armbruster R.W.
        Detection of myocardial perfusion in multiple echocardiographic windows with one intravenous injection of microbubbles using transient response second harmonic imaging.
        J Am Coll Cardiol. 1997; 29: 791-799