COMBINED USE OF CONTRAST-ENHANCED 2-DIMENSIONAL AND COLOR DOPPLER-ECHOCARDIOGRAPHY FOR IMPROVED LEFT-VENTRICULAR ENDOCARDIAL BORDER DELINEATION USING LEVOVIST, A NEW VENOUS ECHOCARDIOGRAPHIC CONTRAST AGENT

Transthoracic echocardiography often provides inadequate endocardial b order visualization, particularly of the left ventricular apex. The ai m of this study was to determine whether the transpulmonary echocardio graphic contrast agent, Levovist, could improve endocardial visualizat ion. Accordingly, 43 patients underwent 2-dimensional echocardiography before and after intravenous administration of Levovist. Definition o f the left ventricular septal, apical and lateral borders was graded: 0 = no definition, 1 = partial definition, 2 = complete definition. Co lor Doppler was performed before and after contrast in 32/43 patients and similarly scored to determine any further benefit in apical border detection. There was significant (p < 0.001) improvement of the avera ge end-diastolic scores of the septal, apical and lateral regions (1.4 +/- 0.5, 0.6 +/- 0.7 and 0.9 +/- 0.5 before and 1.8 +/- 0.4, 1.4 +/- 0.6 and 1.7 +/- 0.5 after Levovist). The average end-systolic score wa s significantly different (p < 0.001) from end-diastolic values in the apex only (0.3 +/- 0.6 before and 0.8 +/- 0.7 after Levovist). Averag e apical scores using color Doppler improved from 0.3 +/- 0.6 and 0.1 +/- 0.2 during end-diastole and end-systole to 1.7 +/- 0.5 and 1.2 +/- 0.6, respectively, after Levovist (p < 0.001); the average end-diasto lic contrast-enhanced color Doppler score was significantly higher tha n the corresponding grey scale score (p < 0.001). We conclude that lef t ventricular endocardial border definition is significantly improved by Levovist. The use of contrast enhanced color Doppler can compensate for limited efficacy of this method in the apex.