Use of contrast for image enhancement during stress echocardiography is cost-effective and reduces additional diagnostic testing.

1. Etchells E, Bell C, Robb K. Does this patient have a systolic murmur? JAMA 1997;277:564–571. 2. ACC/AHA Task Force on Practice Guidelines, Committee on Clinical Application of Echocardiography. ACC/AHA Guidelines for the Clinical Application of Echocardiography. Circulation 1997;95:1686–1744. 3. Smythe, JF, Teixeira OHP, Vlad P, Demers PP, Feldman W. Initial evaluation of heart murmurs: are laboratory tests necessary? Pediatrics 1990;86:497–500. 4. Geva T, Hegesh J, Frand M. Reappraisal of the approach to the child with heart murmurs: is echocardiography mandatory? Int J Cardiol 1988;19:107–113. 5. Fink JC, Schmidt CH, Selker HP. A decision aid for referring patients with systolic murmurs for echocardiography. J Gen Intern Med 1994;9:479–484. 6. Xu M, McHaffie DJ. Nonspecific systolic murmurs: an audit of the clinical value of echocardiography. N Zealand Med J 1993;106:54–56. 7. Roldan CA, Shivley BK, Crawford MH. Value of the cardiovascular physical examination for detecting valvular heart disease in asymptomatic subjects. Am J Cardiol 1996;77:1327–1331. 8. Danjani AS, Taubert KA, Wilson W, Bolger AF, Bayer A, Ferrieri P, Gewitz MH, Shulman ST, Nouri S, Newburger JW, et al. Prevention of bacterial endocarditis: recommendations of the American Heart Association. JAMA 1997; 277:1794–1801. 9. McCracken D, Everett JE. An investigation of the incidence of precordial murmurs in young healthy women. Practitioner 1976;216:308–309. 10. Stewart IMG. Systolic murmurs in 525 healthy young adults. Br Heart J 1951;13:561–565. 11. Maron BJ, Thompson PD, Puffer JC, McGrew CA, Strong WB, Douglas PS, Clark LT, Mitten MJ, Crawford MH, Atkins DL, Driscoll DJ, Epstein AE. Cardiovascular pre-participation screening in competitive athletes: a statement for health professionals from the sudden death committee (clinical cardiology) and congenital cardiac defects committee (cardiovascular disease in the young), American Heart Association. Circulation 1996;94:850–856.