Echocardiography contrast for image optimization: beyond confidence, it is a matter of accuracy.

Current agents not only scatter and reflect, but also interact with administered ultrasound through harmonic and multipulse sequencing to increase signal intensity over background tissue noise. Modifications in the agents, along with these unique methods of ultrasound delivery and reception, have resulted in robust and persistent contrast effect. There has been wide clinical acceptance of contrast agents for the application of improving echocardiographic imaging in patients for whom initial transthoracic images are technically suboptimal. Administration of these agents in a busy clinical practice has been shown to be efficient and cost-effective (1). Accurate visualization of endocardial borders is of crucial importance in stress echocardiography, as this technique involves assessment of global and segmental wall thickening and motion (2). In this test, the endocardial border must be assessed quickly and in multiple planes. Not surprisingly, this has become the area of echocardiography in which contrast agents are most frequently used.