Sonicated serum albumin in contrast echocardiography: improved segmental wall motion depiction and implications for stress echocardiography.

We undertook to study the ability of intravenously administered sonicated albumin microbubbles to opacify the left ventricular (LV) cavity, enhance endocardial delineation, and thereby improve the interpreter's confidence in evaluating regional wall motion in patients whose baseline echocardiograms were believed to be technically difficult because of limited endocardial resolution. We studied 30 adult patients with endocardial border dropout of greater than or equal to 20% on routine echocardiography. Efficacy was evaluated by the investigator and 2 blinded observers using an opacification grading system of 0 (no appearance in LV cavity) to 3+ (full LV chamber opacification). Effective opacification was indicated by a score of greater than or equal to 2+. Border delineation improvement equaled a change from grade A (not well delineated) to grade B, C, or D (well delineated) of at least 1 of 6 LV wall segments. Initially all patients received a 0.08 mL/kg injection. The patient received 2 additional injections of 0.14 and 0.08 mL/kg given 5 minutes apart if the initial volume produced at least 2+ LV opacification. Otherwise, a final injection of 0.22 mL/kg was given. In all cases, the patients' arms were raised after injection to enhance venous passage. When graded by the investigator, 29 patients (97%) exhibited greater than or equal to 2+ opacification. When graded by the blinded observers, 27 patients (90%) exhibited greater than or equal to 2+ opacification. Improved border delineation was noted by the investigator in 90% of patients, and the blinded observers noted improvement in 97% (excluding 1 patient who, if scored by a blinded observer, would have received a higher dose of contrast agents).(ABSTRACT TRUNCATED AT 250 WORDS)