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 border visualization, particularly of the left ventricular apex. The aim of this study was to determine whether the transpulmonary echocardiographic contrast agent, Levovist, could improve endocardial visualization. Accordingly, 43 patients underwent 2-dimensional echocardiography before and after intravenous administration of Levovist. Definition of the left ventricular septal, apical and lateral borders was graded: 0 = no definition, 1 = partial definition, 2 = complete definition. Color 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 average 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 was 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). Average 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-diastolic contrast-enhanced color Doppler score was significantly higher than the corresponding grey scale score (p < 0.001). We conclude that left 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.