title: Does contrast echocardiography with Optison induce myocardial necrosis in humans?
abstract: Myocardial contrast echocardiography is a promising diagnostic tool for detecting microvascular integrity. Multiple experimental laboratories have shown that diagnostic combined microbubble contrast and ultrasound exposure can cause vessel rupture and myocardial damage in laboratory animals. This study investigated the phenomenon of contrast ultrasonically induced myocardial damage in human beings. Twenty consecutive patients (mean age of 60 +/- 12 years, 14 men) underwent contrast echocardiography with intravenous Optison using a mechanical index of at least 1.4 (Vivid Five System (GE, Vingmed Ultrasound, Horton, Norway). Creatine kinase (CK), creatine kinase-isoenzyme MB (CK-MB); CK-MB mass, myoglobin, and troponin I were measured before and 2, 4, 8, and 24 hours after contrast echocardiography. There was no significant correlation concerning the response to contrast echocardiography for any pair of parameters at any time after the intervention. Only in 2 patients were there higher values for troponin I before and after contrast echocardiography without an increase of myoglobin, CK, or CK-MB mass and activity. These values were therefore interpreted as false positive because of renal failure and severe heart failure. The use of contrast echocardiography is without demonstrated risk of myocardial damage even in patients with different cardiologic entities.
authors.affiliation: Medizinische Klinik (Kardiologie, Pneumologie und Angiologie), Universitätsklinikum Charité, Humboldt-Universität, Berlin, Germany. adrian.borges@charite.de
authors.forename: Adrian C
authors.initials: AC
authors.lastname: Borges
authors.forename: Torsten
authors.initials: T
authors.lastname: Walde
authors.forename: Rona K
authors.initials: RK
authors.lastname: Reibis
authors.forename: Andrea
authors.initials: A
authors.lastname: Grohmann
authors.forename: Reinhard
authors.initials: R
authors.lastname: Ziebig
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rutsch
authors.forename: Ingolf
authors.initials: I
authors.lastname: Schimke
authors.forename: Gert
authors.initials: G
authors.lastname: Baumann
mesh_terms: D000368:Aged; D000418:Albumins / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D003287:Contrast Media / Q000009:adverse effects*; D003402:Creatine Kinase / Q000097:blood; D004452:Echocardiography / Q000009:adverse effects*; D005260:Female; D005466:Fluorocarbons / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging; D009206:Myocardium / Q000473:pathology*; D009211:Myoglobin / Q000097:blood; D009336:Necrosis; D011446:Prospective Studies
chemical_list: D000418:Albumins; D015415:Biomarkers; D003287:Contrast Media; C099458:FS 069; D005466:Fluorocarbons; D009211:Myoglobin; D003402:Creatine Kinase