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Contrast Echocardiography in Heart Failure: Update 2023

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Abstract

Purpose of Review

The application of ultrasound-enhancing agents (contrast agents) has improved the accuracy and reproducibility of echocardiography. The review focuses on the currently approved and evolving indications for contrast echocardiography in patients with heart failure, specifically examining clinical studies conducted after the publication of the guidelines in 2017 and 2018.

Recent Findings

The current ASE/EACVI recommendations for contrast echocardiography are based on its accuracy and reproducibility in comparison to non-enhanced echocardiography or other imaging modalities like cardiac MRI. However, tissue characterization remains limited with contrast echocardiography. During the last few years, several studies have demonstrated the clinical impact of using contrast agents on the management of patients with heart failure. There is growing evidence on the benefit of using contrast echocardiography in critically ill patients where echocardiography without contrast agents is often suboptimal and other imaging methods are less feasible. There is no risk of worsening renal function after the administration of ultrasound-enhancing agents, and these agents can be administered even in patients with end-stage renal disease.

Summary

Contrast echocardiography has become a valuable tool for first-line imaging of patients with heart failure across the spectrum of patients with chronic heart failure to critically ill patients.

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Data Availability

All studies included in this review have been published and are available on Pubmed database.

Abbreviations

AHA:

American Heart Association

ASE:

American Society of Echocardiography

CRT:

Cardiac resynchronization therapy

EACVI:

European Association of Cardiovascular Imaging

EF:

Ejection fraction

ECMO:

Extracorporeal membrane oxygenation

ICD:

Implantable cardioverter defibrillator

ICU:

Intensive care unit

LV:

Left ventricle

LVAD:

Left ventricular assist device

MI:

Mechanical index

MRI:

Magnetic resonance imaging

TTE:

Transthoracic echocardiography

TEE:

Transesophageal echocardiography

UEA:

Ultrasound-enhancing agent

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

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Funding

All authors receive salaries for their academic positions at the University of Alberta Hospital. No grant support was received from manufacturers of ultrasound equipment of ultrasound-enhancing agents.

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Authors and Affiliations

  1. ABACUS, Mazankowski Alberta Heart Institute, University of Alberta Hospital, 0A8.32, 8440 112 Street Edmonton, Alberta, T6G 2B7, Canada

    Harald Becher, Waleed Alhumaid, Jonathan Windram & Jonathan Choy

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  1. Harald Becher
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  2. Waleed Alhumaid
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Contributions

HB conceived and designed the analysis, collected data, performed the analysis, and wrote the manuscript. WA collected and contributed data and wrote the manuscript. JW performed the analysis and reviewed the manuscript. JC performed the analysis and reviewed the manuscript.

Corresponding author

Correspondence to Harald Becher.

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Competing Interests

Dr. BECHER reports grants and personal fees from Lantheus , grants and personal fees from Bracco Imaging, during the conduct of the study; personal fees from Oxford University Press, personal fees from Springer/Nature, grants from Ultromics, outside the submitted work

Ethical Approval and Consent to Participate

The research protocols of the research studies in this review were approved by local and international review boards. Written consent of the participants was obtained unless there was a waiver for collecting data from hospital databases.

Conflict of Interest

HB received research grants from Lantheus and Bracco, consulting for Lantheus and honorarium for presentation at Bracco-sponsored satellite symposium. There is no competing interests for the other authors.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Becher, H., Alhumaid, W., Windram, J. et al. Contrast Echocardiography in Heart Failure: Update 2023. Curr Heart Fail Rep 21, 63–72 (2024). https://doi.org/10.1007/s11897-024-00647-z

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