Definity and Optison are perflutren-based ultrasound contrast agents used in echocardiography.
United States Food and Drug Administration warnings regarding serious cardiopulmonary
reactions and death after Definity administration highlighted the limited safety data
in patients who undergo contrast stress echocardiography. From 1998 and 2007, 2,022
patients underwent dobutamine stress echocardiography and 2,764 underwent exercise
stress echocardiography with contrast at the Cleveland Clinic. The echocardiographic
database, patient records, and the Social Security Death Index were reviewed for the
timing and cause of death, severe adverse events, arrhythmias, and symptoms. Complication
rates for contrast dobutamine stress echocardiography and exercise stress echocardiography
were compared with those in a control group of 5,012 patients matched for test year
and type who did not receive contrast. Ninety-five percent of studies were performed
in outpatients. There were no differences in the rates of severe adverse events (0.19%
vs 0.17%, p = 0.7), death within 24 hours (0% vs 0.04%, p = 0.1), cardiac arrest (0.04%
vs 0.04%, p = 0.96), and sustained ventricular tachycardia (0.2% vs 0.1%, p = 0.32)
between patients receiving and not receiving intravenous contrast, respectively. In
conclusion, severe adverse reactions to intravenous contrast agents during stress
echocardiography are uncommon. Contrast use does not add to the baseline risk for
severe adverse events in patients who undergo stress echocardiography.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- WFUMB Safety Symposium on Echo-Contrast Agents: nature and types of ultrasound contrast agents.Ultrasound Med Biol. 2007; 33: 187-196
- The clinical applications of contrast echocardiography.Eur J Echocardiogr. 2007; 8: S13-S23
- Effect of intravenous contrast for left ventricular opacification and border definition on sensitivity and specificity of dobutamine stress echocardiography compared with coronary angiography in technically difficult patients.Am Heart J. 2001; 142: 908-915
- Contrast dobutamine stress echocardiography: clinical practice assessment in 300 consecutive patients.J Am Soc Echocardiogr. 2001; 14: 378-385
- A randomized cross-over study for evaluation of the effect of image optimization with contrast on the diagnostic accuracy of dobutamine echocardiography in coronary artery disease.J Am Coll Cardiol Imaging. 2008; 1: 145-152
United States Food and Drug Administration. Micro-bubble contrast agents (marketed as Definity [perflutren lipid microsphere] injectable suspension and Optison [perflutren protein-type A microspheres for injection]). Available at: http://www.fda.gov/medwatch/safety/2007/safety07.htm#bubble. Accessed January 4, 2008.
- Contrast echocardiography: past, present and . . . future?.J Am Coll Cardiol Imaging. 2008; 1: 107-110
- Product safety compromises patient safety (an unjustified black box warning on ultrasound contrast agents by the Food and Drug Administration).Am J Cardiol. 2008; 101: 892-893
- Acute mortality in hospitalized patients undergoing echocardiography with and without an ultrasound contrast agent: results in 18,671 patients.J Am Coll Cardiol. 2008; 51: 1704-1706
- Thinking outside the “box”—the ultrasound contrast controversy.J Am Coll Cardiol. 2007; 50: 2434-2437
- Maximal oxygen intake and nomographic assessment of functional aerobic impairment in cardiovascular disease.Am Heart J. 1973; 85: 546-562
- Economic impact of contrast stress echocardiography on the diagnosis and initial treatment of patients with suspected coronary artery disease.J Am Soc Echocardiogr. 2002; 15: 1335-1345
- Use of contrast for image enhancement during stress echocardiography is cost-effective and reduces additional diagnostic testing.Am J Cardiol. 2001; 87: 1430-1432
- Prognostic value of dobutamine stress myocardial contrast perfusion echocardiography.Circulation. 2005; 112: 1444-1450
United States Food and Drug Administration. Information for healthcare professionals: micro-bubble contrast agents (marketed as Definity [perflutren lipid microsphere] injectable suspension and Optison [perflutren protein-type A microspheres for injection]). Available at: http://www.fda.gov/cder/drug/InfoSheets/HCP/microbubbleHCP.htm. Accessed January 4, 2008.
- Methodology, feasibility, safety and diagnostic accuracy of dobutamine stress echocardiography.J Am Coll Cardiol. 1997; 30: 595-606
- Safety of stress echocardiography supervised by registered nurses: results of a 2-year audit of 15,404 patients.J Am Soc Echocardiogr. 2008; 21: 337-341
- Safety of stress echocardiography (from the International Stress Echo Complication Registry).Am J Cardiol. 2006; 98: 541-543
- National survey of exercise stress testing facilities.Chest. 1980; 77: 94-97
Article info
Publication history
Published online: September 09, 2008
Accepted:
June 17,
2008
Received in revised form:
June 17,
2008
Received:
April 24,
2008
Footnotes
Dr Gabriel is supported by an Overseas Training and Research Fellowship Award from the National Heart Foundation of New Zealand, Auckland, New Zealand.
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
