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Safety and Risk–Benefit Profile of Microbubble Contrast Agents in Echocardiography
Definity and Optison that will include a large retrospective study using be familiar with and have access to medications (most importantly
a hospital database to determine acute mortality in hospitalized epinephrine) to treat allergic-type reactions. ■
patients undergoing echocardiography with an without an ultrasound
contrast agent, and an invasive hemodynamic study to evaluate for Supported by Lantheus Medical Imaging. The views expressed are those of
changes in pulmonary artery pressure and resistance immediately the authors and not necessarily those of Lantheus Medical Imaging.
following contrast agent administration.
30
Conclusions
Taiyeb M Khumri, MD, is a third-year Fellow in General
Cardiology at the University of Missouri, Kansas City, of
The ‘Boxed Warning’ disease state contraindications and mandated which Saint Luke’s Mid-America Heart Institute is an
30-minute monitoring period issued by the FDA in October 2007 had
affiliated teaching hospital. He completed one year
dedicated to research in the field of echocardiography
a chilling effect on ultrasound contrast agent use in the US. Seven
that focused on the utilization of echo contrast for
recently published studies have shown that: serious adverse events left ventricular opacification and for myocardial
consistent with anaphylactoid reactions occur in ~1:10,000 patient
perfusion echocardiography.
doses; there is no increased mortality in patients undergoing
contrast echocardiography compared with patients undergoing
Michael L Main, MD, is a partner at Cardiovascular
Consultants, a 41-physician private practice cardiology
echocardiography without an ultrasound contrast agent, despite the
group in Kansas City, Missouri, an Associate Professor of
fact that patients receiving an ultrasound contrast agent exhibit more
Medicine at the University of Missouri-Kansas City, and
comorbidities and higher acuity of illness; and contrast administration
Medical Director of the Echocardiography Laboratory at
Saint Luke’s Mid-America Heart Institute. He completed
is safe in stress echocardiography. Based on these data and other
an internship and residency in internal medicine at the
considerations, the FDA recently revised product labeling
University of Texas Southwestern Medical School
for both agents, and clinicians can once again perform contrast
affiliated hospitals (Parkland Memorial Hospital and the
Dallas Veteran’s Affairs Medical Center), and subsequently completed a fellowship in
echocardiography in those patients most likely to derive
cardiovascular disease at the University of Texas Southwestern Medical Center and an
diagnostic benefit. Although these agents are ‘safe,’ physicians and
advanced cardiac imaging fellowship at the Cleveland Clinic. Dr Main received his MD
sonographers performing contrast echocardiography should be
from the University of Iowa College of Medicine in 1991.
aware of the potential for a rare anaphylactoid reaction, and should
1. Feinstein SB, Cheirif J, Ten Cate FJ, et al., Safety and efficacy intensive care unit patients, J Am Coll Cardiol, 2000;35:485–90. hospitalized patients undergoing echocardiography with and
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an intravenous perfluorocarbon contrast agent improves Group, Am J Manag Care, 1998;4:SP169–76. J Am Coll Cardiol, 2008; in press.
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reproducible measurement of left ventricular volume and contrast for image enhancement during stress 27. Gabriel RS, Smyth YM, Menon V, et al., Safety of Ultrasound
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echocardiography clarifies uninterpretable wall motion in 21. Kusnetzky LL, Khalid A, Khumri TM, et al., Acute mortality in
US CARDIOLOGY 19
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