Regional wall motion abnormality shown on contrast-enhanced echocardiography

Multiple imaging modalities were used to assess left ventricular function in a 64-year-old patient with prior inferior myocardial infarction. The Figure shows systolic and diastolic images of 4 different imaging modalities using different views. Regional wall motion abnormality was not detected using unenhanced echocardiography because of limited visualization of the inferior/posterior wall.

To improve visualization of the endocardial border, contrast echocardiography was performed with an administration of intravenous contrast agent (SonoVue^®, Bracco Imaging, Italy) using a starting infusion rate of 1 mL/min. The infusion rate was adjusted to 1.5 mL/min to reach homogenous left ventricular cavity opacification without attenuation. Additional bolus injections of contrast were used to reach sufficient cavity opacification. Contrast-specific imaging at a low mechanical index of 0.3 was selected (gain, 60%; compression, 15%). To optimize imaging conditions for endocardial border definition, transmit power, gain, focus, and dynamic range were modulated as required.

Contrast echocardiography showed a wall motion abnormality of the basal inferior/posterior wall. This wall motion abnormality could also be shown by cardiac magnetic resonance imaging and cineventriculography. Assessment of global left ventricular function showed an ejection fraction of 60%, indicating normal global function. Coronary angiography was performed, which showed occlusion of the right coronary artery. The patient underwent percutaneous coronary intervention with revascularization and stent placement in the right coronary artery.