Alterations of right ventricular assessment by use of an ultrasound-enhancing agent during routine visualization of the left ventricle

Aims: Two-dimensional echocardiography remains the primary means of right ventricular (RV) evaluation. This study evaluated effects of ultrasound contrast, employed to improve left ventricular (LV) visualization, on assessment of RV size and function. Methods and results: In 100 consecutive patients where an ultrasound enhancing agent (UEA) was indicated to improve LV visualization, apical 4-chamber (A4C) views were collected before and after contrast injection, maintaining transducer position. For the last 50 subjects, RV-focused (RVF) views were also obtained. Images were presented in random order to four echocardiographers with varying levels of experience. They were tasked with determining which ventricle formed the apex, whether the RV free wall was adequately visualized, assessing RV size and contractility and reporting their confidence level in their readings. In both A4C and RVF views, the LV was less often determined to be apex-forming when UEA was used and RV size assessments moved in the direction of dilated for all readers. Similarly, a determination of reduced RV contractility occurred more often with UEA. Many of these differences were statistically significant. Interestingly, RV free wall visualization was not improved with contrast use. Moreover, reader confidence in interpretation was actually reduced when contrast was employed, with statistically significant differences for all four readers in the A4C view and two readers in the RVF view. Conclusion: Opportunistic evaluation of the RV after employing UEA resulted in significant differences in visual assessment of various RV parameters. Reader confidence in interpretation was not improved when contrast was used.