The added clinical value of second generation ultrasound contrast agents.

Intravenous contrast echocardiography using second generation contrast agents improves wall motion analysis in difficult-to-image patients and increases diagnostic accuracy of stress echocardiography. New and still experimental technology enables simultaneous evaluation of myocardial perfusion and wall motion. First clinical and experimental studies demonstrate an acceptable diagnostic accuracy of intravenous contrast echocardiography in detecting stress-induced ischemia and in differentiating viable from irreversibly damaged myocardium. Current data encourage the use of intravenous contrast echocardiography to evaluate microvascular integrity in patients with unstable angina and in acute infarction following coronary revascularization. However, attenuation artefacts may limit interpretation of findings in basal myocardial segments. Standardization of the method on the basis of more solid data derived from large clinical trials is needed before introducing intravenous myocardial contrast echocardiography into clinical practice.