American Society of Echocardiography Consensus Statement on the Clinical Applications of Ultrasonic Contrast Agents in Echocardiography.

UNLABELLED ACCREDITATION STATEMENT: The American Society of Echocardiography (ASE) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The ASE designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit.trade mark Physicians should only claim credit commensurate with the extent of their participation in the activity. The American Registry of Diagnostic Medical Sonographers and Cardiovascular Credentialing International recognize the ASE's certificates and have agreed to honor the credit hours toward their registry requirements for sonographers. The ASE is committed to resolving all conflict-of-interest issues, and its mandate is to retain only those speakers with financial interests that can be reconciled with the goals and educational integrity of the educational program. Disclosure of faculty and commercial support sponsor relationships, if any, have been indicated. TARGET AUDIENCE This activity is designed for all cardiovascular physicians, cardiac sonographers, and nurses with a primary interest and knowledge base in the field of echocardiography; in addition, residents, researchers, clinicians, sonographers, and other medical professionals having a specific interest in contrast echocardiography may be included. OBJECTIVES Upon completing this activity, participants will be able to: 1. Demonstrate an increased knowledge of the applications for contrast echocardiography and their impact on cardiac diagnosis. 2. Differentiate the available ultrasound contrast agents and ultrasound equipment imaging features to optimize their use. 3. Recognize the indications, benefits, and safety of ultrasound contrast agents, acknowledging the recent labeling changes by the US Food and Drug Administration (FDA) regarding contrast agent use and safety information. 4. Identify specific patient populations that represent potential candidates for the use of contrast agents, to enable cost-effective clinical diagnosis. 5. Incorporate effective teamwork strategies for the implementation of contrast agents in the echocardiography laboratory and establish guidelines for contrast use. 6. Use contrast enhancement for endocardial border delineation and left ventricular opacification in rest and stress echocardiography and unique patient care environments in which echocardiographic image acquisition is frequently challenging, including intensive care units (ICUs) and emergency departments. 7. Effectively use contrast echocardiography for the diagnosis of intracardiac and extracardiac abnormalities, including the identification of complications of acute myocardial infarction. 8. Assess the common pitfalls in contrast imaging and use stepwise, guideline-based contrast equipment setup and contrast agent administration techniques to optimize image acquisition.

[1]  J. Seward,et al.  Stress echocardiography. Part I. Exercise echocardiography: techniques, implementation, clinical applications, and correlations. , 1995, Mayo Clinic proceedings.

[2]  A. Makaryus,et al.  Contrast echocardiography improves the diagnostic yield of transthoracic studies performed in the intensive care setting by novice sonographers. , 2005, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[3]  R S Meltzer,et al.  Food and Drug Administration ultrasound device regulation: the output display standard, the "mechanical index," and ultrasound safety. , 1996, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[4]  L. Faber,et al.  Targeting percutaneous transluminal septal ablation for hypertrophic obstructive cardiomyopathy by intraprocedural echocardiographic monitoring. , 2000, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[5]  J. Seward,et al.  Harmonic imaging: echocardiographic enhanced contrast intensity and duration , 1999, The International Journal of Cardiac Imaging.

[6]  W. Hundley,et al.  Effect of contrast enhancement on transthoracic echocardiographic assessment of left ventricular regional wall motion. , 1999, The American journal of cardiology.

[7]  T. Marwick,et al.  Incremental Benefit of Myocardial Contrast to Combined Dipyridamole-Exercise Stress Echocardiography for the Assessment of Coronary Artery Disease , 2004, Circulation.

[8]  T C Skalak,et al.  Direct In Vivo Visualization of Intravascular Destruction of Microbubbles by Ultrasound and Its Local Effects on Tissue. , 1998, Circulation.

[9]  G W Rouan,et al.  Clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room. , 1987, The American journal of cardiology.

[10]  M. Lauer,et al.  Use of exercise echocardiography for prognostic evaluation of patients with known or suspected coronary artery disease. , 1997, Journal of the American College of Cardiology.

[11]  M. Kern,et al.  Effect of intravenous contrast for left ventricular opacification and border definition on sensitivity and specificity of dobutamine stress echocardiography compared with coronary angiography in technically difficult patients. , 2001, American heart journal.

[12]  P. Mottram,et al.  Mitral valve thrombus mimicking a primary tumor in the antiphospholipid syndrome. , 2002, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[13]  W. Lepper,et al.  Assessment of the vascularity of a left ventricular mass using myocardial contrast echocardiography. , 2002, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[14]  L. Branco Accuracy and feasibility of contrast echocardiography for detection of perfusion defects in routine practice. Comparison with wall motion and technetium--99m sestamibi single--photon emission computed tomography. , 1999, Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology.

[15]  A. Pasquet,et al.  Assessment of the physiologic significance of coronary disease with dipyridamole real-time myocardial contrast echocardiography. Comparison with technetium-99m sestamibi single-photon emission computed tomography and quantitative coronary angiography. , 2004, Journal of the American College of Cardiology.

[16]  B. Gerber,et al.  Release of cardiac bio-markers during high mechanical index contrast-enhanced echocardiography in humans. , 2007, European heart journal.

[17]  S. Nakatani,et al.  Enhancement of Doppler flow signals in the left heart chambers by intravenous injection of sonicated albumin. , 1993, Journal of the American College of Cardiology.

[18]  J. Kisslo,et al.  Opacification and border delineation improvement in patients with suboptimal endocardial border definition in routine echocardiography: results of the Phase III Albunex Multicenter Trial. , 1991, Journal of the American College of Cardiology.

[19]  U. Gleichmann,et al.  Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: results with respect to intraprocedural myocardial contrast echocardiography. , 1998, Circulation.

[20]  J. Pérez,et al.  Apical hypertrophic cardiomyopathy: echocardiographic diagnosis with the use of intravenous contrast image enhancement. , 2000, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[21]  L. Wann,et al.  ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR 2008 appropriateness criteria for stress echocardiography: a report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, American Society of Echocardiography, American College of Emergency Physicians, American Heart Association, , 2008, Journal of the American College of Cardiology.

[22]  P. Serruys,et al.  Preservation of global and regional left ventricular function after early thrombolysis in acute myocardial infarction. , 1986, Journal of the American College of Cardiology.

[23]  Patricia A Pellikka,et al.  American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography. , 2007, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[24]  J. Seward,et al.  Recommendations for training in performance and interpretation of stress echocardiography. Committee on Physician Training and Education of the American Society of Echocardiography. , 1998, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[25]  A R Jayaweera,et al.  Coronary and myocardial blood volumes: noninvasive tools to assess the coronary microcirculation? , 1997, Circulation.

[26]  Contrast echocardiography improves the accuracy and reproducibility of left ventricular remodeling measurements: a prospective, randomly assigned, blinded study. , 2001, Journal of the American College of Cardiology.

[27]  P A van Der Wouw,et al.  Premature ventricular contractions during triggered imaging with ultrasound contrast. , 2000, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[28]  J. Seward,et al.  Stress echocardiography. Part II. Dobutamine stress echocardiography: techniques, implementation, clinical applications, and correlations. , 1995, Mayo Clinic proceedings.

[29]  S. Feinstein,et al.  Effect of contrast enhancement on measurement of carotid artery intimal medial thickness. , 2002, Vascular medicine.

[30]  Ingolf Schimke,et al.  Does contrast echocardiography with Optison induce myocardial necrosis in humans? , 2002, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[31]  A. Khalid,et al.  Acute mortality in hospitalized patients undergoing echocardiography with and without an ultrasound contrast agent: results in 18,671 consecutive studies. , 2008, Journal of the American College of Cardiology.

[32]  P. Grayburn,et al.  Thinking outside the "box"-the ultrasound contrast controversy. , 2007, Journal of the American College of Cardiology.

[33]  Salim Yusuf,et al.  Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. , 1991, The New England journal of medicine.

[34]  M. Verani,et al.  Real-time assessment of myocardial perfusion and wall motion during bicycle and treadmill exercise echocardiography: comparison with single photon emission computed tomography. , 2001, Journal of the American College of Cardiology.

[35]  M. Monaghan,et al.  Atrial and pulmonary mass: intracardiac thrombus mimicking myxoma on multiplane transesophageal echocardiography. , 1997, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[36]  F. Pashkow,et al.  Accuracy and limitations of exercise echocardiography in a routine clinical setting. , 1992, Journal of the American College of Cardiology.

[37]  A. Elhendy,et al.  Safety of dobutamine stress real-time myocardial contrast echocardiography. , 2005, Journal of the American College of Cardiology.

[38]  S. Kaul,et al.  Regional left ventricular perfusion and function in patients presenting to the emergency department with chest pain and no ST-segment elevation. , 2005, European heart journal.

[39]  T. Ryan,et al.  American society of echocardiography , 2000 .

[40]  G. Plotnick,et al.  Use of an intravenous contrast agent (Optison(TM)) to enhance echocardiography: Efficacy and cost implications , 1998 .

[41]  M. Alonzo,et al.  Safety and Efficacy of Intravenous Contrast Imaging in Pediatric Echocardiography , 2005, Pediatric Cardiology.

[42]  C. Hanefeld,et al.  Occlusion of pseudoaneurysms using human or bovine thrombin using contrast-enhanced ultrasound guidance. , 2004, The American journal of cardiology.

[43]  R. Okada,et al.  Early changes in left ventricular size and function after correction of left ventricular volume overload. , 1981, The American journal of cardiology.

[44]  S. Siu,et al.  Feasibility and accuracy of left ventricular volumes and ejection fraction determination by fundamental, tissue harmonic, and intravenous contrast imaging in difficult-to-image patients. , 2000, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[45]  L. Shaw,et al.  Diagnostic accuracy and cost-effectiveness of contrast echocardiography on evaluation of cardiac function in technically very difficult patients in the intensive care unit. , 2002, The American journal of cardiology.

[46]  J. Shanewise,et al.  Right-sided cardiac tumors detected by transesophageal echocardiography and its usefulness in differentiating the benign from the malignant ones. , 1997, The American journal of cardiology.

[47]  William A Zoghbi,et al.  A randomized cross-over study for evaluation of the effect of image optimization with contrast on the diagnostic accuracy of dobutamine echocardiography in coronary artery disease The OPTIMIZE Trial. , 2008, JACC. Cardiovascular imaging.

[48]  O. Kamp,et al.  Accuracy and feasibility of contrast echocardiography for detection of perfusion defects in routine practice: comparison with wall motion and technetium-99m sestamibi single-photon emission computed tomography. The Nycomed NC100100 Investigators. , 1998, Journal of the American College of Cardiology.

[49]  J. Bella,et al.  Efficacy and time-efficiency of a "sonographer-driven" contrast echocardiography protocol in a high-volume echocardiography laboratory. , 2003, American heart journal.

[50]  E. Foster,et al.  Transesophageal echocardiographic (TEE) evaluation of intracardiac and pericardial masses. , 2000, Cardiology clinics.

[51]  N. Weissman,et al.  Infusion versus bolus contrast echocardiography: a multicenter, open-label, crossover trial. , 2000, American heart journal.

[52]  I. Fidler,et al.  Critical factors in the biology of human cancer metastasis. , 1995, The American surgeon.

[53]  I. Schnittger,et al.  Contrast echocardiography is superior to tissue harmonics for assessment of left ventricular function in mechanically ventilated patients. , 2000, American heart journal.

[54]  B. Khandheria,et al.  Contrast echocardiography: beyond a black box warning? , 2008, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[55]  C. Herzog,et al.  Incidence of adverse events associated with use of perflutren contrast agents for echocardiography. , 2008, JAMA.

[56]  T R Porter,et al.  Improved endocardial border resolution during dobutamine stress echocardiography with intravenous sonicated dextrose albumin. , 1994, Journal of the American College of Cardiology.

[57]  Randolph P. Martin,et al.  Guidelines for optimal physician training in echocardiography. Recommendations of the American Society of Echocardiography Committee for Physician Training in Echocardiography. , 1987, The American journal of cardiology.

[58]  T. Porter,et al.  Real-time perfusion imaging with low mechanical index pulse inversion Doppler imaging. , 2001, Journal of the American College of Cardiology.

[59]  S. Feinstein,et al.  Contrast ultrasound imaging of the carotid artery vasa vasorum and atherosclerotic plaque neovascularization. , 2006, Journal of the American College of Cardiology.

[60]  S. Siu,et al.  Determination of left ventricular ejection fraction using intravenous contrast and a semiautomated border detection algorithm. , 2003, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[61]  W. Bommer,et al.  Contrast microbubbles improve diagnostic yield in ICU patients with poor echocardiographic windows. , 2001, Chest.

[62]  Lynn Weinert,et al.  Comparison of contrast-enhanced real-time live 3-dimensional dobutamine stress echocardiography with contrast 2-dimensional echocardiography for detecting stress-induced wall-motion abnormalities. , 2006, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[63]  Peter N. Burns,et al.  Harmonic power mode Doppler using microbubble contrast agents: an improved method for small vessel flow imaging , 1994, 1994 Proceedings of IEEE Ultrasonics Symposium.

[64]  T. Porter,et al.  Transient myocardial contrast after initial exposure to diagnostic ultrasound pressures with minute doses of intravenously injected microbubbles. Demonstration and potential mechanisms. , 1995, Circulation.

[65]  T. Kimball,et al.  Is there a role for intravenous transpulmonary contrast imaging in pediatric stress echocardiography? , 2003, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[66]  Jean-Claude Tardif,et al.  Economic impact of contrast stress echocardiography on the diagnosis and initial treatment of patients with suspected coronary artery disease. , 2002, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[67]  Navin C. Nanda,et al.  Advances in Echo Imaging Using Contrast Enhancement , 1997, Springer Netherlands.

[68]  S. Kaul,et al.  Detection of coronary artery disease with myocardial contrast echocardiography: comparison with 99mTc-sestamibi single-photon emission computed tomography. , 1997, Circulation.

[69]  V. Mor-Avi,et al.  Assessment of left ventricular function with contrast echocardiography. , 2004, Cardiology clinics.

[70]  I. Gradus-Pizlo,et al.  Echocardiographic imaging of technically difficult patients in the intensive care unit: use of optison in combination with fundamental and harmonic imaging. , 2001, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[71]  P. Burns Harmonic imaging with ultrasound contrast agents. , 1996, Clinical radiology.

[72]  Mario J. Garcia,et al.  Contrast and Harmonic Imaging Improves Accuracy and Efficiency of Novice Readers for Dobutamine Stress Echocardiography , 2002, Echocardiography.

[73]  B. Lüderitz,et al.  Real‐Time Contrast Echo Assessment of Myocardial Perfusion at Low Emission Power , 1999, Echocardiography.

[74]  L. Bolondi,et al.  The safety of Sonovue in abdominal applications: retrospective analysis of 23188 investigations. , 2006, Ultrasound in medicine & biology.

[75]  H. Leong-Poi,et al.  Images in cardiovascular medicine. Isolated left ventricular noncompaction enhanced by echocontrast agent. , 2007, Circulation.

[76]  B. Gordon Current procedural terminology , 1966 .

[77]  P. Grayburn,et al.  Assessment of myocardial perfusion by harmonic power Doppler imaging at rest and during adenosine stress: comparison with (99m)Tc-sestamibi SPECT imaging. , 2000, Circulation.

[78]  H. Becher,et al.  Safety of contrast dobutamine stress echocardiography: a single center experience. , 2005, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[79]  M. Alam Pitfalls in the Echocardiographic Diagnosis of Intracardiac and Extracardiac Masses , 1993, Echocardiography.

[80]  Sigmund Frigstad,et al.  Accurate and reproducible measurement of left ventricular volume and ejection fraction by contrast echocardiography: a comparison with magnetic resonance imaging. , 2004, Journal of the American College of Cardiology.

[81]  C. Maynard,et al.  Results of coronary artery surgery in patients with poor left ventricular function (CASS). , 1983, Circulation.

[82]  M. Verani,et al.  Role of myocardial contrast echocardiography during nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy. , 1998, Journal of the American College of Cardiology.

[83]  P. Pellikka,et al.  Contrast dobutamine stress echocardiography: clinical practice assessment in 300 consecutive patients. , 2001, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[84]  R M Peshock,et al.  Administration of an intravenous perfluorocarbon contrast agent improves echocardiographic determination of left ventricular volumes and ejection fraction: comparison with cine magnetic resonance imaging. , 1998, Journal of the American College of Cardiology.

[85]  T. Porter,et al.  Comparison of low-mechanical index pulse sequence schemes for detecting myocardial perfusion abnormalities during vasodilator stress echocardiography. , 2005, The American journal of cardiology.

[86]  Y. Arakaki,et al.  Collateral vessels assessed by myocardial contrast echocardiography in patients with coronary artery lesions after Kawasaki disease , 2007, Heart and Vessels.

[87]  J. V. Nixon,et al.  Early echocardiography can predict cardiac events in emergency department patients with chest pain. , 1998, Annals of emergency medicine.

[88]  J. Gottdiener,et al.  Efficacy and safety of the novel ultrasound contrast agent perflutren (definity) in patients with suboptimal baseline left ventricular echocardiographic images. , 2000, The American journal of cardiology.

[89]  G. Plotnick,et al.  Use of an intravenous contrast agent (Optison) to enhance echocardiography: efficacy and cost implications. Optison Multicenter Study Group. , 1998, The American journal of managed care.

[90]  C. Chin,et al.  Pulse inversion Doppler: a new method for detecting nonlinear echoes from microbubble contrast agents , 1999, IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control.

[91]  C. Stefanadis,et al.  Safety of myocardial flash-contrast echocardiography in combination with dobutamine stress testing for the detection of ischaemia in 5250 studies , 2008, Heart.

[92]  S. Kaul,et al.  Influence of microbubble surface charge on capillary transit and myocardial contrast enhancement. , 2002, Journal of the American College of Cardiology.

[93]  I. Kronzon,et al.  Contrast echocardiography clarifies uninterpretable wall motion in intensive care unit patients. , 2000, Journal of the American College of Cardiology.

[94]  A. Gopal,et al.  Differential diagnosis of intracavitary tumors obstructing the right ventricular outflow tract. , 2001, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[95]  Peter N. Burns,et al.  Imaging instrumentation for ultrasound contrast agents , 1997 .

[96]  F J Ten Cate,et al.  Safety and efficacy of a new transpulmonary ultrasound contrast agent: initial multicenter clinical results. , 1990, Journal of the American College of Cardiology.

[97]  R Erbel,et al.  Analysis of interinstitutional observer agreement in interpretation of dobutamine stress echocardiograms. , 1996, Journal of the American College of Cardiology.

[98]  S. Mulvagh,et al.  Assessment of the Vascularity of a Left Atrial Mass Using Myocardial Perfusion Contrast Echocardiography , 2008, Echocardiography.

[99]  J. Pérez,et al.  Diagnosis of cardiac rupture with the use of contrast-enhanced echocardiography. , 2000, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[100]  S. Witt Implementing microbubble contrast in the echocardiography laboratory: a sonographer's perspective. , 2002, The American journal of cardiology.

[101]  D Ehler,et al.  Guidelines for the cardiac sonographer in the performance of contrast echocardiography: recommendations of the American Society of Echocardiography Council on Cardiac Sonography. , 2001, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[102]  A. DeMaria,et al.  Feasibility of right ventricular myocardial opacification by contrast echocardiography and comparison with left ventricular intensity. , 1999, The American journal of cardiology.

[103]  J. Powers,et al.  Premature Ventricular Contractions During Triggered Imaging With Ultrasound Contrast. , 2000, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[104]  S. Nakatani,et al.  Clinical application of transpulmonary contrast-enhanced Doppler technique in the assessment of severity of aortic stenosis. , 1992, Journal of the American College of Cardiology.

[105]  J. Weiss,et al.  Comparison of usefulness of dipyridamole stress myocardial contrast echocardiography to technetium-99m sestamibi single-photon emission computed tomography for detection of coronary artery disease (PB127 Multicenter Phase 2 Trial results). , 2003, The American journal of cardiology.

[106]  J. Stratton,et al.  Transthoracic contrast echocardiographic detection of ascending aortic dissection. , 1999, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[107]  K. Schechtman,et al.  Use of contrast for image enhancement during stress echocardiography is cost-effective and reduces additional diagnostic testing. , 2001, The American journal of cardiology.

[108]  J J Bax,et al.  Refinements in stress echocardiographic techniques improve inter-institutional agreement in interpretation of dobutamine stress echocardiograms. , 2002, European heart journal.

[109]  J. Seward,et al.  Outcome after normal exercise echocardiography and predictors of subsequent cardiac events: follow-up of 1,325 patients. , 1998, Journal of the American College of Cardiology.

[110]  William D O'Brien,et al.  Arrhythmias in Rat Hearts Exposed to Pulsed Ultrasound After Intravenous Injection of a Contrast Agent , 2002, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[111]  Scott R. Kerns,et al.  Advances in Echo Imaging Using Contrast Enhancement , 1995 .

[112]  A R Jayaweera,et al.  Quantification of myocardial blood flow with ultrasound-induced destruction of microbubbles administered as a constant venous infusion. , 1998, Circulation.

[113]  J. Chambers,et al.  Clinical Safety of SonoVue™, a New Contrast Agent for Ultrasound Imaging, in Healthy Volunteers and in Patients with Chronic Obstructive Pulmonary Disease , 2001, Investigative radiology.

[114]  S. Siu,et al.  Contrast-enhanced quantitation of left ventricular ejection fraction: what is the best method? , 2001, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[115]  B. Cosyns,et al.  Bio-effects of ultrasound contrast agents in daily clinical practice: fact or fiction? , 2007, European heart journal.

[116]  B. Kimura,et al.  Utility of contrast echocardiography in the diagnosis of aortic dissection. , 1999, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[117]  P. Grayburn Product safety compromises patient safety (an unjustified black box warning on ultrasound contrast agents by the Food and Drug Administration). , 2008, The American journal of cardiology.

[118]  S. Kaul,et al.  Enhancement of left ventricular cavity opacification by harmonic imaging after venous injection of Albunex. , 1997, The American journal of cardiology.

[119]  K. Schechtman,et al.  Improved echocardiographic delineation of left ventricular thrombus with the use of intravenous second-generation contrast image enhancement. , 1999, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[120]  Lynn Weinert,et al.  Differential diagnosis of cardiac masses using contrast echocardiographic perfusion imaging. , 2004, Journal of the American College of Cardiology.

[121]  Julio E. Pérez,et al.  Intravenous albunex during dobutamine stress echocardiography: enhanced localization of left ventricular endocardial borders. , 1995, American heart journal.

[122]  Harald Becher,et al.  Assessment of systolic left ventricular function: a multi-centre comparison of cineventriculography, cardiac magnetic resonance imaging, unenhanced and contrast-enhanced echocardiography. , 2005, European heart journal.

[123]  J G Miller,et al.  Contrast Echocardiography: Current and Future Applications , 2000 .

[124]  Steven B. Feinstein,et al.  Contrast-enhanced ultrasound imaging of atherosclerotic carotid plaque neovascularization: a new surrogate marker of atherosclerosis? , 2007, Vascular medicine.

[125]  T. Porter,et al.  Detection of myocardial perfusion in multiple echocardiographic windows with one intravenous injection of microbubbles using transient response second harmonic imaging. , 1997, Journal of the American College of Cardiology.

[126]  D S Segar,et al.  Improved left ventricular endocardial border delineation and opacification with OPTISON (FS069), a new echocardiographic contrast agent. Results of a phase III Multicenter Trial. , 1998, Journal of the American College of Cardiology.

[127]  S. Kaul,et al.  Myocardial contrast echocardiography versus Thrombolysis In Myocardial Infarction score in patients presenting to the emergency department with chest pain and a nondiagnostic electrocardiogram. , 2005, Journal of the American College of Cardiology.

[128]  K. Kuntz,et al.  Exercise echocardiography or exercise SPECT imaging? A meta-analysis of diagnostic test performance. , 1998, JAMA.

[129]  C. Brennen Cavitation and Bubble Dynamics , 1995 .

[130]  Roxy Senior,et al.  Contrast echocardiography: evidence for clinical use. , 2008, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[131]  M. Chino,et al.  Primary cardiac sarcoma mimicking benign myxoma: a case report. , 2002, Journal of cardiology.

[132]  E. Picano,et al.  Diagnostic and prognostic value of dipyridamole echocardiography in patients with suspected coronary artery disease. Comparison with exercise electrocardiography. , 1994, Circulation.

[133]  S. Kaul,et al.  Value of regional wall motion abnormality in the emergency room diagnosis of acute myocardial infarction. A prospective study using two-dimensional echocardiography. , 1991, Circulation.

[134]  J. Seward,et al.  Role of dobutamine stress echocardiography in predicting outcome in 860 patients with known or suspected coronary artery disease. , 1998, Circulation.

[135]  Janos Szebeni,et al.  Complement activation-related pseudoallergy: a new class of drug-induced acute immune toxicity. , 2005, Toxicology.