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Backgrounds: Although there is a wealth of information regarding contrast echocardiography (CE) improved visualization of endocardial borders and with regard to improving assessment of left ventricular (LV) function. However, there has been no data about clinical usefulness of CE in routine clinical echocardiography in Asian population. The aim of this study was to evaluate the impact of contrast echocardiography on assessment of ventricular function and clinical diagnosis in routine clinical echocardiography in Asian population.Methods: We prospectively enrolled 260 patients (mean age 62 ± 15) from 11 general hospitals in Korea with technically difficult echocardiographic studies who received intravenous contrast Definity (Lantheus Medical Imaging, Billerica, Massachusetts). Quality of studies, number of visualized LV segments, estimated ejection fraction, ability to identify LV wall motion abnormality, visualization of LV apex, right ventricular (RV) function, any changes in diagnostic procedure and treatment strategy were compared before and after contrast.Results: After CE, the percent of poor or uninterpretable studies decreased from 28.3% to 2.1% (p < 0.001), technically adequate studies increased from 24.6% to 83.3% (p < 0.001) and average number of uninterpretable LV wall motion abnormality was decreased from 71.1% to 12.9. Before contrast, 9.63 ± 3.3 of 17 LV segments were seen, which improved after CE to 14.63 ± 2.1 (p<0.001). An ability to visualize LV apex was increased from 14.9% to 84.4% (p<0.001) and RV visualization also improved from 15.2% to 45.5% (p<0.001). A significant impact of CE on management was observed: any changes in diagnostic procedures after CE was 30% of patients and treatment plan was altered in 29% of patients.Conclusions: The utilization of CE in technically difficult cases improves endocardial visualization and impacts cardiac diagnosis and patient management in routine clinical echocardiography in Asian population.