Safety of Contrast Administration for Endocardial Enhancement During Stress Echocardiography Compared With Noncontrast Stress

Shaikh, Kamran A.; Chang, Su-Min; Peterson, Leif E.; Rosendahl-Garcia, Kathleen; Quiñones, Miguel Á.; Nagueh, Sherif F.; Kurrelmeyer, Karla M.; Zoghbi, William A.

doi:10.1016/j.amjcard.2008.07.032

Cited by 40 publications

(28 citation statements)

References 28 publications

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“…2 Ultrasound contrast, on the other hand, has been shown to be safe in thousands of patients, without side effects and with only a very low risk (1 in 15 000) of an anaphylactoid reaction. [27][28][29][30][31][32][33][34] Although myocardial perfusion was more sensitive than wall motion for detection of CAD, wall motion analysis may also provide some additional information. The segments with induced wall motion abnormalities often persisted even into the 4-to-6 -minute period after the bolus, which indicates that stunning may have occurred, because perfusion at this stage was returning to normal.…”

Section: Discussionmentioning

confidence: 99%

Rapid Detection of Coronary Artery Stenoses With Real-Time Perfusion Echocardiography During Regadenoson Stress

Porter

Adolphson

High

et al. 2011

Circ: Cardiovascular Imaging

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Background-Real-time myocardial contrast echocardiography permits the detection of myocardial perfusion abnormalities during stress echocardiography, which may improve the accuracy of the test in detecting coronary artery stenoses. We hypothesized that this technique could be used after a bolus injection of the selective A2A receptor agonist regadenoson to rapidly and safely detect coronary artery stenoses. Methods and Results-In 100 patients referred for quantitative coronary angiography, real-time myocardial contrast echocardiography was performed during a continuous intravenous infusion of 3% Definity at baseline and at 2-minute intervals for up to 6 minutes after a regadenoson bolus injection (400 g). Myocardial perfusion was assessed by examination of myocardial contrast replenishment after brief high mechanical index impulses. A perfusion defect was defined as a delay (Ͼ2 seconds) in myocardial contrast replenishment in 2 contiguous segments. Wall motion was also analyzed. The overall sensitivity/specificity/accuracy for myocardial perfusion analysis in detecting a Ͼ50% diameter stenosis was 80%/74%/78%, whereas for wall motion analysis it was 60%/72%/66% (PϽ0.001 for differences in sensitivity). Sensitivity for myocardial perfusion analysis was highest on images obtained during the first 2 minutes after regadenoson bolus (PϽ0.001 compared with wall motion), whereas wall motion sensitivity was highest at the 4-to-6 -minute period after the bolus. No significant side effects occurred after regadenoson bolus injection. Conclusions-Regadenoson

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Section: Discussionmentioning

confidence: 99%

Rapid Detection of Coronary Artery Stenoses With Real-Time Perfusion Echocardiography During Regadenoson Stress

Porter

Adolphson

High

et al. 2011

Circ: Cardiovascular Imaging

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“…Herzog [12] assessed 16,025 patients over 10 years, and Gabriel et al [13] from the Cleveland Clinic assessed 2022 patients who underwent dobutamine stress echocardiography and 2764 who underwent exercise stress echocardiography with perfl utren-containing contrast agents. Shaikh et al [14] assessed 5069 patients (in which 2914 received contrast) showing similar fi ndings.…”

Section: Safety Of Contrast Agentsmentioning

confidence: 58%

Contrast echocardiography: An update

Chelliah¹,

Senior

2009

Curr Cardiol Rep

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Despite the advent of tissue harmonic imaging, echocardiography fails to produce diagnostically useful images in a significant proportion of patients. This often leads to inaccurate assessment of left ventricular function, necessitating the use of other, more expensive and laborious imaging techniques, purely for diagnostic purposes. This has facilitated the development of microbubbles, which together with ultrasound, produce opacification of the left ventricular cavity, thus enabling clear visualization and accurate quantification of left ventricular function. Contrast agents have also facilitated the development of myocardial contrast echocardiography. This allows assessment of cardiac anatomy, function, and perfusion, all in one sitting, by the bedside. Contrast ultrasound imaging also has now been applied to newer techniques (eg, real-time three-dimensional echocardiography) and is also showing promise in other cardiovascular scans (eg, carotid ultrasound for intima-media thickness). Thus, contrast agents play a pivotal role in noninvasive cardiovascular imaging and its use worldwide is likely to increase.

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“…Subsequent observational studies refined (i.e., substantially weakened) the signal for the major events of death, myocardial infarction, and arrhythmias but supported a low risk of anaphylactoid reactions [12,[14][15][16][17][18][19][20][21][22][23][24][25][26][27]. The product label evolved dynamically in response to this accumulating information.…”

Section: Discussionmentioning

confidence: 99%

“…Although use of this agent has steadily increased since then, as of at least 2011 it had not fully rebounded to the rate of use prior to 2007 [11]. Subsequent observational studies and meta-analysis evaluating the aforementioned signal provide important information [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. The multiple observational studies failed to detect an increased risk of the major cardiovascular events of death, myocardial infarction, and arrhythmia due to perflutren [12,[14][15][16][17][18][19][20][21][22][23][24][25][26][27].…”

Section: Introductionmentioning

confidence: 98%

“…The multiple observational studies failed to detect an increased risk of the major cardiovascular events of death, myocardial infarction, and arrhythmia due to perflutren [12,[14][15][16][17][18][19][20][21][22][23][24][25][26][27]. However, studies supported the rare occurrence of anaphylactoid reactions due to perflutren [21,26]. Despite the maturity of the signal evaluation to date (e.g., multiple observational studies performed in response to a signal generated by individual spontaneous reports), we report a dual-purpose statistical aggregate analysis of spontaneous report with perflutren.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Safety of Perflutren Ultrasound Contrast Agents: A Disproportionality Analysis of the US FAERS Database

et al. 2015

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Safety of Contrast Administration for Endocardial Enhancement During Stress Echocardiography Compared With Noncontrast Stress

Cited by 40 publications

References 28 publications

Rapid Detection of Coronary Artery Stenoses With Real-Time Perfusion Echocardiography During Regadenoson Stress

Rapid Detection of Coronary Artery Stenoses With Real-Time Perfusion Echocardiography During Regadenoson Stress

Contrast echocardiography: An update

Safety of Perflutren Ultrasound Contrast Agents: A Disproportionality Analysis of the US FAERS Database

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