Contrast echocardiography and medical economics: looking in our crystal ball.

The past decade has witnessed the development of contrast echocardiography. This technique has demonstrated clinical utility in some applications (left ventricular opacification for assessment of left ventricular function during technically difficult procedures and stress echocardiography) and extremely promising results have been reported for others (assessment of myocardial perfusion). However, even though the feasibility of myocardial contrast echocardiography is now well established, there are still several obstacles to its acceptance by regulatory authorities and routine users (e.g. technical difficulties, limitations in the reproducibility and quantification of contrast enhancement, difficulties in image interpretation, and lack of reimbursement). In addition, the efficacy and cost-effectiveness have to be proven against ‘gold standard’ techniques, which in several cases are just accepted standards. Furthermore, the competition is quite strong both between new techniques (magnetic resonance imaging, multislice or electron beam computed tomography, and positron emission tomography) and with established ones (coronary angiography and single-photon emission computed tomography). In this complex environment all of the imaging modalities need to find their most appropriate role. Contrast echocardiography may become an important diagnostic tool in cardiology, because it allows simultaneous assessment of ventricular function and myocardial perfusion. Further investigations may identify ways to measure intra-cavitary pressure, and to deliver drugs and gene therapies by means of those microbubbles that are presently used as contrast agents.