Organization of the Contrast Echocardiography Laboratory: Tips and Tricks

  • Teresa López Fernández
  • Esther Pérez David
  • Mar Moreno Yangüela
  • José Luis Zamorano
  • Miguel Angel García Fernández


Recently, developments and advances have been made in echocardiography so as to improve the diagnostic evaluation of car diac structures and function. Among these new innovations during the last decade, the use of contrast echocardiography (CE) has gained great interest because it can provide, non-invasively, new information about coronary microcirculation and myocardial perfusion. Started in 1968, with the use of handagitated saline as a source of ultrasonic contrast, CE was based on the concept of creating a gas-blood interface for enhancement of blood within the heart [1]. By injecting small amounts of physiologically safe microbubbles for visualization of tissues and chambers, a new level of physiological imaging has been developed.


Contrast Agent Myocardial Perfusion Myocardial Blood Flow Coronary Flow Reserve Mechanical Index 
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  1. 1.
    Feigenbaum H, Stone J, Lee D, Nasse W, Chang S: Identification of ultrasound echoes from the left ventricle by use of intracardiac injections of indocyanine green. Circulation 1970; 41: 615–621PubMedCrossRefGoogle Scholar
  2. 2.
    Kaul S. Instrumentation for contrast echocardiography: technology and techniques. Am J Cardiol 2002; 90(suppl):8J–14JPubMedCrossRefGoogle Scholar
  3. 3.
    Wei K, Skyba DM, Firschke C, Lindner JR, Jayaweera AR, Kaul S. Interaction between microbubbles and ultrasound: in vitro and in vivo observations. J Am Coll Cardiol 1997; 29: 1081–1088PubMedCrossRefGoogle Scholar
  4. 4.
    Skyba DM, Price RJ, Linka AZ, Skalak TC, Kaul S. Direct in vivo visualization of intravascular destruction of microbubbles by ultrasound and its local effects on tissue. Circulation 1998; 98: 290–293PubMedCrossRefGoogle Scholar
  5. 5.
    Tamyel A, Havaux X, Van Camp G, Campanelle B, Gisellu G, Pasquet A, Denf JF, Melen JA, Vanover-schelde JL. Destruction of contrast microbubbles by ultrasound. Effects on myocardial function, coronary perfusion pressure and microvascular integrity. Circulation 2001; 104: 461–466CrossRefGoogle Scholar
  6. 6.
    Masugata H, Lafitte S, Peters B, Strachan GM, DeMaria AN. Comparison of real-time and intermittent triggered myocardial contrast echocardiography for quantification of coronary stenosis severity and transmural perfusion gradient. Circulation 2001; 104: 1550–1556PubMedCrossRefGoogle Scholar
  7. 7.
    Aggeli CJ, Shimon S, Nagueh SF, Zoghbi WA. Quantitative parameters of myocardial perfusion with contrast echocardiography in human beings: influ ence of triggering mode. J Am Soc Echocardiogr 2002; 15: 1432–1439PubMedCrossRefGoogle Scholar
  8. 8.
    Porter TR, Xie F, Li S, D’Sa A, Rafter P. Increased ultrasound contrast and decreased micro bubble destruction rates with triggered ultrasound imaging. J Am Soc Echocardiogr 1996; 9: 599–605PubMedCrossRefGoogle Scholar
  9. 9.
    De Jong N. Imaging methods for MCE: what to expect in near future. Eur J Echocardiography 2002; 3: 245–306Google Scholar
  10. 10.
    Porter TR, Li S, Jiang L, Grayburn P, Deligonul U. Real-time visualization of myocardial perfusion and wall thickening in human beings with intravenous ultrasonographic contrast and accelerated intermittent harmonic imaging. J Am Soc Echocardiogr 1999; 12: 266–271PubMedCrossRefGoogle Scholar
  11. 11.
    Bahlmann EB, Mc Quillan BM, Handschumacher MD, Chow CM, Guerrero JL, Picard MH, Weyman AE, Scherrer-Crosbie M. Effect of destructive pulse duration on the detection of myocardial perfusion in myocardial contrast echocardiography: in vitro and in vivo observations. J Am Soc Echocardiogr 2002;15: 1440–1447PubMedCrossRefGoogle Scholar
  12. 12.
    Kaul S. Myocardial contrast echocardiography: 15 years of research and development. Circulation 1997; 96: 3745– 3760PubMedCrossRefGoogle Scholar
  13. 13.
    Kuersten B, Nahar T, Vannan MA. Methods of contrast administration for myocardial perfusion imaging: continuous infusion versus bolus injection. Am J Cardiol 2002; 90 (suppl): 35J–37JPubMedGoogle Scholar
  14. 14.
    Kaul S, Kelly P, Oliner JD, Glasheen WP, Keller MW, Watson DD. Assessment of regional myocardial blood flow with myocardial contrast two-dimensional echocardiography. J Am Coll Cardiol 1989; 13:468–482PubMedCrossRefGoogle Scholar
  15. 15.
    Wiencek JG, Feinstein SB, Walker R, Aroson S. Pitfalls in quantitative contrast echocardiography: the steps to quantification of perfusion. J Am Soc Echocardiogr 1993; 6(4): 395–416PubMedGoogle Scholar
  16. 16.
    Skyba DM, Jayaweera AR, Goodman NC, Ismail S, Caramaro GP, KaulS. Quantification of myocardial perfusion with myocardial contrast echocardiography from left atrial injection of contrast: implications for venous injection. Circulation 1994; 90:1513–1521PubMedCrossRefGoogle Scholar
  17. 17.
    Weissman NJ, Mylan CC, Hack TC, Gillam LD, Cohen JL, Kitzman DW. Infusion versus bolus contrast echocardiography: a multicenter, open-label, crossover trial. Am Heart J 2000; 139: 399–404PubMedCrossRefGoogle Scholar
  18. 18.
    Wei K, Jayaweera AR, Firoozan S, Linka A, Skyba DM, Kaul S. Basis for detection of stenosis using venous administration of microbubbles during myocardial contrast echocardiography: Bolus or continuous infusion? J Am Coll Cardiol 1998; 32: 252–260PubMedCrossRefGoogle Scholar
  19. 19.
    Murthy TH, Li P, Locvicchio E, Baisch C, Dairywala I, Armstrong WF, Vannan M. Real time myocardial blood flow imaging in normal human beings with the use of myocardial contrast echocardiography. J Am Soc Echocardiogr 2001; 14: 698–705PubMedCrossRefGoogle Scholar
  20. 20.
    Lindner JR, Villanueva FS, Dent JM, Wei K Sklenar J, Kaul S. Assessment of resting perfusion with myocardial contrast echocardiography: theoretical and practical considerations. Am Heart J 2000; 139: 231–240PubMedGoogle Scholar
  21. 21.
    Wei K, Jayaweera AR, Firoozan S, Linka A, Skyba DM, Kaul S. Quantification of myocardial blood flow with ultrasound-induced destruction of microbubbles administered as a contrast venous infusion. Circulation 1998; 97: 473– 483PubMedCrossRefGoogle Scholar
  22. 22.
    Porter TR, Xie F, Li S, Kricsfeld D, Deligonul U. Effect of transducer standoff on the detection, spatial extent and quantification of myocardial contrast defects caused by coronary stenosis. J Am Soc Echocardiogr 1999; 12: 951–956PubMedCrossRefGoogle Scholar
  23. 23.
    Coggins MP, Sklenar JD, Le E, Wei K, Lindner JR, Kaul S. Non-invasive prediction of ultimate infarct size at the time of acute coronary occlusion based on the extent and magnitude of collateral-derived myocardial blood flow. Circulation 2001; 104: 2471–2477PubMedCrossRefGoogle Scholar
  24. 24.
    Witt S. Implementing microbubble contrast in the echocardiography laboratory. A sonographer’s perspective. Am J Cardiol 2002; 90 (suppl): 155–165CrossRefGoogle Scholar
  25. 25.
    Burgess P, Moore V, Bednarz J, Carney D, Floer S, Gresser C, Jasper S, Moos S, Odabastian J, Sisk E, Trough M, Waggoner A, Witt S, Adams D. Performing an echocardiographic examination with a contrast agent: a series on contrast echocardiography II. J Am Soc Echocardiogr 2000; 13: 629–634PubMedCrossRefGoogle Scholar
  26. 26.
    Beker H, Burns PN. Assessment of myocardial perfusion by contrast echocardiography. Left ventricular function and myocardial perfusion. Beker H, Burns PN editors. Handbook of contrast echocardiography. 2000; 128–133Google Scholar
  27. 27.
    Lindner JR, Villanueva FS, Dent JM, Sklenar J, Kaul S. Assessment of resting perfusion with myocardial contrast echo: theoretical and practical considerations. Am Heart J 2000; 139: 231–240PubMedGoogle Scholar
  28. 28.
    Pare JC, Saquete N, Sirges M, Velamazán M. Organización del laboratorio de ecocardiografía de contraste. García-Fernández MA, Zamorano JL. Editors. Práctica de la ecocardiografía de contraste. Madrid: ENE, 1999:107–113Google Scholar
  29. 29.
    Lutz C, Tie Mann K, Kosher J, Schlosser T, Grenache J, Belcher H. Does colour blooming limitate the assessment of myocardial perfusion using harmonic power Doppler? Euro Heart J 1999; 20(abstract supplement): 359Google Scholar
  30. 30.
    Sklenar J, Jayaweera AR, Linka Az, Kaul S. Paramet ric imaging for myocardial contrast echocardiography: pixel-to-pixel incorporation of information from both spatial and temporal domains: method for the myocardial perfusion evaluation during myocardial contrast two-dimensional echocardiography. J Am Soc Echocardiogr 1998; 25: 461–464Google Scholar
  31. 31.
    Ay T D, Hondt AM, Pasquet A, Melin JA, Vanoverss-chelde JL. Heterogeneity of contrast effect during intermittent second harmonic myocardial contrast echocardiography in healthy patients. J Am Soc Echocardiogr 2002; 15:1448–1452PubMedCrossRefGoogle Scholar
  32. 32.
    Kerber R, Kioschos J, Lauer R. Use of an ultrasound contrast method in the diagnosis of valvular regurgitation and intra-cardiac shunts. Am J Cardiol 1974; 34:722PubMedCrossRefGoogle Scholar
  33. 33.
    Hagler DJ, Currie PJ, Seward JB, Tajik AJ, Mair DD, Ritter DG. Echocardiographic contrast enhancement of poor or weak continuous-wave Doppler signals. Echocardiography 1987; 4:63CrossRefGoogle Scholar
  34. 34.
    Nakatani S, Imanishi T, Terasawa A, Beppu S, Nagata S, Miyatake K. Clinical application of trans-pulmonary contrast enhanced Doppler technique in the assessment of severity of aortic stenosis. J Am Coll Cardiol 1992; 20:973PubMedCrossRefGoogle Scholar
  35. 35.
    Tanabe K, Asanuma T Yoshitomi H. Doppler estimation of pulmonary artery end-diastolic pressure using contrast enhancement of pulmonary regurgitation signals. Am J Cardiol 1996; 78:1145PubMedGoogle Scholar
  36. 36.
    Lambertz H, Schumacher U, Tries H, Stein T. Improvement of pulmonary venous flow Doppler signal after intravenous injection of Levovist. J Am Soc Echocardiogr 1997; 10:891PubMedCrossRefGoogle Scholar
  37. 37.
    Rey JR, García-Fernández MA, Pérez E. Utilidad de la inyección de ecopotenciadores de la señal Doppler en la estimación de la presión sistólica pulmonar en pacientes sin insuficiencia tricúspide. Rev Esp Cardiol 1998; 51 (supl5):31Google Scholar
  38. 38.
    Schiller N, Shah P, Crawford M, DeMaria A, Devereux R, Feigenbaum H for the American Society of Echocardiography Committee on Standards, Subcommittee on Quantification of Two-dimensional Echocardiograms. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr 1989; 2:358–367PubMedGoogle Scholar
  39. 39.
    Lang RM, Mor-Avi V, Zoghbi WA, Senior R, Klein AL, Pearlman AS. The role of contrast enhancement of left ventricular function. Am J Cardiol 2002; 90 (suppl): 28J–34JPubMedCrossRefGoogle Scholar
  40. 40.
    Lindner JR, Dent JM, Moos SP, Jayaweera AR, Kaul S. Enhancement of left ventricular cavity opacification by harmonic imaging after venous injection of Albunex. Am J Cardiol 1997; 79:1657–1662PubMedCrossRefGoogle Scholar
  41. 41.
    Spencer KT, Bednarz J, Mor-avi V, Weinert L, Tan J, Godoy I, Lang RM. The role of echocardiographic harmonic imaging and contrast enhancement for the improvement of endocardial border delineation. J Am Soc Echocardiogr 2000; 13: 131–135PubMedGoogle Scholar
  42. 42.
    Fernández Portales J, Garcia Fernández MA, Moreno M, González Alujas MT, Placer JL, Allue C, Bermejo J, Delcán JL. Utilidad de las nuevas técnicas de imagen, segundo armónico y contraste en la visualización del borde endocárdico. Análisis de la reproducibilidad en la valoración de la contracción segmentaria. Rev Esp Cardiol 2000; 53: 1459–1466CrossRefGoogle Scholar
  43. 43.
    Hundley WG, Kizilbash AM, Afridi I, Franco F, Peshock RM, Grayburn PA. Administration of an intravenous perfluorocarbon contrast agent improves echocardiographic determination of left ventricular volumes and ejection fraction: comparison with cine magnetic resonance imaging. J Am Coll Cardiol 1998; 32: 1426–1432PubMedCrossRefGoogle Scholar
  44. 44.
    Hundley WG, Kizilbash AM, Afridi I, Franco F, Peshock RM, Grayburn PA. Effect of contrast enhancement on transthoracic echocardiographic assessment of left ventricular regional wall motion. Am J Cardiol 1999; 84:1365–1369PubMedCrossRefGoogle Scholar
  45. 45.
    Nanda NC, Wistran DC, Karlsberg RP, Hack TC, Smith WB, Foley DA, Picard MH, Cotter B. Multicenter evaluation of SonoVue for improved endocardial border delineation. Echocardiography 2002; 19:27–36PubMedCrossRefGoogle Scholar
  46. 46.
    Senior R, Anderson O, Caidahl K, Carlens P, Herre-gods MC, Jenni R, Kenny A, Melcheeer A, Svedenhag J, Vanoverschelde JL. Enhanced left ventricular endocardial border delineation with an intravenous injection of SonoVue, a new echocardiographic contrast agent: A European multicenter study. Echocardiography 2000; 17: 705–711PubMedCrossRefGoogle Scholar
  47. 47.
    Grayburn PA, Mulvagh S, Crouse L. Left ventricular opacification at rest and during stress. Am J Cardiol 2002; 90 (suppl): 21J–27JPubMedCrossRefGoogle Scholar
  48. 48.
    Stratton JR, Lighty GW Pearlman AS, Ritchie JL. Detection of left ventricular thrombus by two-dimensional echocardiography: sensitivity, specificity and causes of uncertainty. Circulation 1982; 66:156–166.PubMedCrossRefGoogle Scholar
  49. 49.
    Reilly JP, Tunick PA, Timmermans RJ, Stein B, Rosen-zweig BP, Kronzon I. Contrast echocardiography clarifies un-interpretable wall motion in intensive care unit patients. J Am Coll Cardiol 2000; 35: 485–490PubMedCrossRefGoogle Scholar
  50. 50.
    Yong Y, Wu D, Fernández V, Kopelen HA, Shimoni S, Nagueh SF, Callahn JD, Bruns DE, Shaw LJ, Quiñones MA, Zoghbi WA. Diagnostic accuracy and cost-effectiveness of contrast echocardiography on evaluation of cardiac function in technically very difficult patients in the intensive care unit. Am J Cardiol 2002; 15: 711–718CrossRefGoogle Scholar
  51. 51.
    National Heart, Lung and Blood Institute. Morbidity from Coronary Heart Disease in the United States.National Heart, Lung and Blood institute Data Fact Sheet. Bethesda (MD): 1990Google Scholar
  52. 52.
    Porter TR, 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: 1440–1443PubMedCrossRefGoogle Scholar
  53. 53.
    Rainbird AJ, Mulvagh Sl, Oh JK, Mccully RB, Klarich KW, Shub C, Mahoney DW, Pellika PA. Contrast dobutamine stress echocardiography: clinical practice assessment in 300 consecutive patients. J Am Soc Echocardiogr 2001; 14:378–385PubMedCrossRefGoogle Scholar
  54. 54.
    Shaw LJ, Monaghan MJ, Nihoyannopolous P. Clinical and economic outcomes assessment with myocardial contrast echocardiography. Heart 1999; 82 (suppl3): III16–III21PubMedGoogle Scholar
  55. 55.
    Kaul S, Senior R, Dittrich H, Raval V, Khattar R, Lahiri A. Detection of coronary artery disease with myocardial contrast echocardiography: comparison with 99mTcsestamibi single photon emission computed tomography. Circulation 1997; 96(3):785–792PubMedCrossRefGoogle Scholar
  56. 56.
    Mor-Avi V, Caiani EG, Collins KA, Korcarz CE, Bednarz JE, Lang RM. Combined assessment of myocardial perfusion and regional left ventricular function by analysis of contrast enhances power modulation images. Circulation 2001; 104: 352–357PubMedCrossRefGoogle Scholar
  57. 57.
    Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, Mark BD, Mc Callister BD, Moss An, O’Reilly MG, Winters WL Jr. ACC/AHA 2002. Guideline update for exercise testing: a report of the American College of Cardiology/ American Heart Association Task Force on Practice guidelines (committee on exercise testing) 2002Google Scholar
  58. 58.
    Villanueva FS. Myocardial contrast echocardiography in acute myocardial infarction. Am J Cardiol 2002; 90(suppl): 38J–47JPubMedCrossRefGoogle Scholar
  59. 59.
    Cain P, Khoury V, Short L, Marwick TH. Usefulness of quantitative echocardiographic techniques to predict recovery of regional and global left ventricular function after acute myocardial infarction. Am J Cardiol 2003; 91: 391–396PubMedCrossRefGoogle Scholar
  60. 60.
    Lepper W, Hoffman R, Kamp O, France A, Cock CC, Kohl HP, Seesawed GT, Dahl JV, Janssens U, Voci P, Visser CA, Hanrath P. Assessment of myocardial reperfusion by intravenous myocardial contrast echocardiography and coronary flow reserve after primary percutaneous transluminal coronary angiography in patients with acute myocardial infarction. Circulation 2000; 101; 2368–2374PubMedCrossRefGoogle Scholar
  61. 61.
    Latiffe S, Higashiyama A, Masugata H, Peters B, Strachan M, Kwan OL, DeMaria AN. Contrast echocardiography can assess risk area and infarct size during coronary occlusion and reperfusion: experimental validation. J Am Coll Cardiol 2002; 39:1546–1554CrossRefGoogle Scholar
  62. 62.
    Zoghbi WA. Evaluation of myocardial viability with contrast echocardiography. Am J Cardiol 2002; 90(suppl): 65J–71JPubMedCrossRefGoogle Scholar
  63. 63.
    Balcells E, Powers ER, Lepper W, Belcik T, Wei K, Ragosta M, Sarnady H, Lindner JR. Detection of myocardial viability by contrast echocardiography in acute infarction predicts recovery of resting function and contractile reserve. J Am Coll Cardiol 2003; 41: 827–833PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2004

Authors and Affiliations

  • Teresa López Fernández
  • Esther Pérez David
  • Mar Moreno Yangüela
  • José Luis Zamorano
  • Miguel Angel García Fernández

There are no affiliations available

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