The American Society of Echocardiography (ASE) has issued a consensus statement, supporting the use of contrast agents used to enhance echocardiogram images, and providing a guide for physicians who may be hesitant to use the contrast agents following a 2007 FDA black-box warning. The statement was published in the November issue of Journal of the American Society of Echocardiography.

In the new statement, supported by expert consensus opinion, critical review and evidence-based research, ASE outlined why, when and how the contrast agents should be used to enhance diagnosis, the role for each person in the lab, and methods to implement contrast in the lab.   

The statement affirmed that contrast enhancement is “an essential part of modern, quality-driven echocardiography laboratories inside and outside the hospital where both resting and stress echo testing are done.”

Acknowledging that the FDA black-box warning, initiated in 2007 and revised in 2008, may weigh heavily on concerned physicians, the ASE outlined the benefits of contrast agents, reviewing the specific contraindications, which include significant intra-cardiac shunts and known hypersensitivity. Beyond the benefits of being able to clearly see heart structures in patients with poor images, most commonly due to intervening fat and lung tissues, the statement suggested that unique benefits include the following:

• Contrast-enhanced echocardiography in the emergency department can play a role in the triage of patients with chest pain through accurate, early diagnosis.
• Contrast enhancement in technically difficult to image patients in the intensive care unit can be used to provide bedside assessment of cardiac structure and function without having to resort to more invasive procedures. 
• The accuracy of contrast echocardiography has been validated for the qualitative and quantitative assessment of the heart chambers, and should be considered in patients whose precise information is clinically required—such as patients under consideration for medical devices or potential heart transplant.

The ASE also noted that contrast agent use is cost-effective when used in an appropriate manner. The ASE advised the medical community that implementation of a contrast program requires a quality commitment on the part of the medical director.