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The use of contrast echocardiography is desirable when the anticipated image improvement may last day com patient management. Contrast agents also improve the signal-to-noise ratio in colour and spectral Doppler echocardiography. This can be used to rescue noisy Doppler studies, in particular studies of aortic valves and pulmonary venous flow.

However, LV opacification is inevitably associated with myocardial opacification, in particular when the newer contrast-specific imaging modalities are used (see Figure 4). Questionable findings of wall motion can be clarified by assessing LV opacification, and vice versa.

Homogeneous myocardial opacification and quick opacification of the myocardial vessels after LV opacification indicate normal myocardial perfusion and provide further confirmation of normal wall motion. This is particularly helpful in stress echocardiography. Reduced opacification in the subendocardial last day com usually indicates reduced last day com and is often easier to appreciate than a new wall motion abnormality, as well as allowing earlier identification of last day com abnormalities (see Figure 1).

For last day com echocardiography the assessment of myocardial opacification is also very helpful. In an akinetic segment, the lack of myocardial opacification indicates viability. Thrombi can be distinguished from tumours by the degree of opacification. The threshold for ultrasound examinations is usually very low and the results of the examinations do not always affect patient management.

Considering the extra time, additional costs and small risk of intolerance, contrast echocardiography requires a more disciplined approach. According to the American Society of Echocardiography (ASE) guidelines, there is an indication for contrast echocardiography when the endocardial border definition is poor in two or more segments.

In some patients, poor visualisation of two myocardial segments may change management, while in others this may not be the case. Stress echo examinations represent a different scenario. Therefore, high image quality is vital. In these patients, contrast administration is of great importance in delineating the endocardial border in all segments, thus changing patient management.

These considerations are reflected in the most recent published guidelines of the British Society of Echocardiography (BSE) and the ASE for the clinical application of stress echocardiography. In rest echocardiography, contrast echocardiography is useful when minor changes of LV volumes and last day com fraction change patient management.

In patients with poor acoustic windows the reproducibility of contrast-enhanced studies is comparable to that of magnetic resonance imaging (MRI) recordings.

Side effects have been reported for ultrasound contrast agents, but they are last day com mild. Data collected during post-marketing surveillance of more than 200,000 SonoVue vials indicate that serious adverse events (SAEs) are rare (0. The signs and symptoms of most of these SAEs indicate an underlying allergy-like mechanism, and were considered by the European Medicines Agency (EMEA) in the context of epidural shots for back pain hypersensitivity reactions.

Last day com kind of reaction (allergy-like) is well known from wide reports in the literature to occur with other medical imaging agents such as X-ray or MRI contrast media.

These contraindications barely affect the use of contrast agents in stress echocardiography for assessment of inducible ischaemia, where it is common practice to exclude unstable patients and symptomatic patients at rest. According to the new contraindications, these patients should not undergo contrast echocardiography.

For instance, a new wall motion last day com is not detected in stress echocardiogram because the wall is not adequately imaged, the diagnosis may be inaccurate and subsequent management of the patient may be wrong. Although last day com appears to be strong evidence that patients with a missed diagnosis of coronary artery disease have an unfavourable outcome, in hematopoiesis there are only limited data to quantify the extent to which this may occur.

Usually, coronary angiography together requested in the case of a last day com stress echocardiogram. Therefore, it is very important to take a decision as to whether to continue with a study last day com has suboptimal images or to consider other possibilities to ensure the patient receives the best possible medical treatment.

Even when the risk of serious adverse events is very low, there should be a clear benefit from the application of the contrast agent to justify its use. Hoodia gordonii patients undergoing stress echocardiography, the benefit of using a contrast agent certainly outweighs the small risks, in particular when the current contraindications are not ignored.

Cardiac MRI, computed tomography (CT) and nuclear methods are known to be considerably more expensive than contrast echocardiography. Several multicentre last day com numerous single-centre trials, as well as series of case reports, have demonstrated the accuracy of contrast echocardiography for assessment of LV volumes and ejection fraction (for an overview see reference 4). The reproducibility of contrast-enhanced echocardiography is as good that of MRI.

The accuracy of stress echocardiography is no worse than that of myocardial scintigraphy. Multislice CT is a new technology that last day com the coronary arteries rather than looking for myocardial ischaemia. The contrast agents applied during MRI, CT and single-photon emission CT (SPECT) examinations pose immediate-term risks, while the radiation used in SPECT and cardiac CT pose long-term risks.

For single tests, however, the incidence of side effects appears to be very last day com for all imaging technologies. Therefore, it is difficult to establish a significant superiority of one method over another in terms of safety.

Data from clinical trials for EMEA or FDA approval are available, but do not provide enough information on rare side effects. Postmarketing surveillance, anecdotal reports on adverse events and a few articles on local registries are other sources last day com compare different technologies.

However, these studies represent different populations and different methods of clinical care. In many patients the clinical course requires several appointments for cardiac imaging. Radiation dosages become an issue in those patients who require non-invasive or invasive coronary angiography and coronary interventions. Contrast application can close the gap between MRI and echocardiography in those patients with suboptimal images.

Even with last day com use of contrast, echocardiography remains a very cost-effective last day com that can be easily integrated into the workflow, either as an outpatient appointment or as treatment on the ward. Published content on this site is for information purposes and is not a substitute for professional medical advice. Radcliffe Cardiology is part of Radcliffe Medical Media, an independent publisher and the Radcliffe Group Ltd.



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