March 2018

The use of ultrasound enhancing agents (UEAs) has become an integral component of echocardiography practice. Since the 2008 American Society of Echocardiography (ASE) consensus statement on clinical applications of ultrasound contrast agents, there have been several important developments, including additional documentation regarding the safety and efficacy of UEA use for improving LVO in several clinical settings. This has been accompanied by the removal and/or reductions of prior contraindications to use and the provision of new clinical data to support use in pediatrics as well as non approved indications such as myocardial perfusion (MP) imaging and therapeutic thrombolysis. Indeed, the data regarding perfusion imaging is so compelling that European guidelines have recommended UEAs as a method of evaluating patients with stable chest pain. In recognition of the large volume of patients enrolled in prospective randomized studies, meta-analyses, registry data, and multicenter comparative effectiveness studies during rest and stress imaging, the Writing Group advises a class of recommendation (COR) and level of evidence (LOE) on diagnostic strategies using UEAs. The recommendations made are according to the updated 2015 American College of Cardiology/American Heart Association clinical practice guidelines. This update focuses on the new data that have been published and how these data, when combined with the 2008 consensus statement and 2014 ASE contrast sonography guidelines, have led to specific recommendations for UEA use in different clinical settings.