Left ventricular endocardial and epicardial border length delineation with perflutren contrast during transthoracic echocardiography

Objective: Precise estimation of wall motion abnormalities during routine echocardiography rests on optimal endocardial border visualization. Endocardial "dropout" may result in the misinterpretation of regional wall motion. Left ventricular opacification (LVO) with intravenous contrast improves the visualization of the left ventricular endocardial border length (EnBL). The purpose of this study was to determine if contrast also improves the visualization of the epicardial border length (EpBL) in addition to the EnBL. Method: This is a single center retrospective observational study. From 200 consecutive patients referred to the Echocardiography Laboratory for the assessment and evaluation of coronary artery disease, 73 patients who received contrast were enrolled. All the images were standardized using offline software. The visualized segments of the epicardium and endocardium were measured in diastole and systole, without and with contrast-enhancement and these segments were summed to provide the total visualized EnBL and EpBL. Results: Contrast enhanced imaging improved EnBL by 65% and 45% in end-diastolic and end-systolic views, respectively. Similarly, EpBL was improved by 61% and 57% in end-diastolic and end-systolic views, respectively (all P values <0.05). Conclusion: Contrast LVO improves the EnBL as previously reported. Additionally, based upon the blinded review of 1,752 regional myocardial wall segments, this study is the first to suggest that contrast also enhances the visualization of the EpBL. This finding has direct clinical implications as the improvement in both EnBL and EpBL with contrast may assist in evaluation of regional left ventricular wall thickening which is a critical parameter used to assess for myocardial ischemia. (Echocardiography 2011;28:761-766)