Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography
Key Points
Recommendations
Current FDA Labeling of UEA Use
Currently Available Commercial UEAs
- All currently approved commercial UEAs contain a high–molecular weight gas encapsulated in a flexible shell.
- All are able to traverse pulmonary and systemic capillary beds, with a size range of 1.1 to 4.5 mm.
- UEA persistence in the circulation is determined by microbubble size, gas composi- tion (diffusivity and solubility), pharmacokinetics, and shell properties.
- Three UEAs (Optison, Definity, and Lumason) are approved for use by the FDA for the indication of LVO; all other applications in cardiovascular disease are off-label uses. Lumason also has approval for adult and pediatric liver imaging, as well as evaluation for vesicoureteral reflux.
RECOMMENDATIONS FOR IMAGING OF UEAs
CLINICAL APPLICATIONS
Use of UEAs in Detecting LV Cavity Abnormalities and Intracardiac Masses
Stress Echocardiographic Imaging with UEAs
UEA Use in Vascular Applications
UEA Use in Critical Care and Emergency Settings
UEA Use in Pediatric Imaging
Safety of UEAs
ECHOCARDIOGRAPHY LABORATORY IMPLEMENTATION OF CONTRAST AGENT USE
COST-EFFECTIVENESS OF UEAS
Although separate reimbursement for UEAs is not provided in the inpatient setting, overall cost savings are realized because of avoidance of downstream diagnostic testing, including TEE and nuclear cardiac testing. Additional costeffectiveness studies are warranted, including evaluation of contrast echocardiography on hospital length of stay.
Recommendation Grading
Abbreviations
- 2D: 2-dimensional
- 3D: 3-dimensional
- ASE: American Society Of Echocardiography
- CAD: Coronary Artery Disease
- CHD: Congenital Heart Disease
- CMRI: Cardiac Magnetic Resonance Imaging
- COR: Class Of Recommendation
- CPT: Current Procedural Terminology
- CT: Computed Tomography
- DSE: Dobutamine Stress Echocardiography
- DUS: Diagnostic Ultrasound
- ECG: Electrocardiography
- ED: Emergency Department
- FDA: Food And Drug Administration
- ICU: Intensive Care Unit
- IV: Intravenous
- LOE: Level Of Evidence
- LV: Left Ventricular
- LVEF: Left Ventricular Ejection Fraction
- LVO: Left Ventricular Opacification
- MBV: Microvascular Blood Volume
- MCE: Myocardial Contrast Echocardiography
- MI: Mechanical Index
- MP: Myocardial Perfusion
- OR: Odds Ratio
- PAD: Peripheral Arterial Disease
- RCT: Randomized Controlled Trial
- RTMCE: Real-time Myocardial Contrast Echocardiography
- RWM: Regional Wall Motion
- SPECT: Single-photon Emission Computerized Tomography
- STEMI: ST-elevation Myocardial Infarction
- TEE: Transesophageal Echocardiography
- TTE: Transthoracic Echocardiography
- UEA: Ultrasound Enhancing Agent
- UTMD: Ultrasound-targeted Microbubble Destruction
- VLMI: Very Low Mechanical Index
Overview
Title
Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography
Authoring Organization
American Society of Echocardiography
Publication Month/Year
March 1, 2018
Last Updated Month/Year
January 22, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adolescent, Adult, Child, Infant, Older adult
Health Care Settings
Ambulatory, Emergency care, Hospital, Outpatient
Intended Users
Radiology technologist, nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Prevention
Diseases/Conditions (MeSH)
D004452 - Echocardiography, D014463 - Ultrasonography
Keywords
echocardiography, ultrasound, Ultrasonic Enhancing Agents
Source Citation
Porter, T. R., Mulvagh, S. L., Abdelmoneim, S. S., Becher, H., Belcik, J. T., Bierig, M., … Villanueva, F. (2018). Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography: 2018 American Society of Echocardiography Guidelines Update. Journal of the American Society of Echocardiography, 31(3), 241–274. doi:10.1016/j.echo.2017.11.013