Contrast echocardiography: what have we learned from the new guidelines?

A new consensus statement on the clinical applications of ultrasound contrast agents was published in November 2008 in the Journal of the American Society of Echocardiography. These guidelines provide the rationale for contrast use, and specifically highlight a number of clinical scenarios in which contrast should always be considered. These include the 1) assessment of left ventricular (LV) systolic function--especially when quantitative LV volumes and ejection fraction, or serial assessments are required, and during stress echocardiography; 2) evaluation of the LV apex; 3) evaluation of mechanical complications of myocardial infarction; 4) evaluation of suspected intracardiac mass; and 5) to enhance Doppler signals in the systemic circulation. Furthermore, detailed outlines on contrast administration, logistics, personnel requirements, and responsibilities are provided. Recent data published in the past 2 years to support these recommendations, and contrast agent safety data, are reviewed in this article.