title: Safety of contrast administration for endocardial enhancement during stress echocardiography compared with noncontrast stress.
abstract: The aim was to evaluate the safety of stress echocardiography using contrast (CE) for endocardial enhancement compared with a noncontrast (NCE) cohort in a large nonselect population. The recent Food and Drug Administration warning cited lack of data for safety regarding the use of contrast in conjunction with stress echocardiography. A detailed record review was performed for 5,069 consecutive patients who underwent stress echocardiography (58% pharmacologic, 42% exercise) during an 8-year period. Contrast use, hemodynamics, and adverse clinical and electrocardiographic events were evaluated until time of discharge from the laboratory. Contrast was administered to 2,914 patients (58%) and was higher in in-patients (66%) and during dobutamine stress (67%). Compared with the NCE group, the CE group was older (median age 61 vs 58 years) and had more depressed left ventricular ejection fraction <50% (14% vs 11%; all p <0.001). The CE group experienced more chest pain (11% vs 8%; p = 0.001), back pain (0.6% vs 0.05%; p <0.001), and premature ventricular contractions (odds ratio 1.42, 95% confidence interval 1.19 to 1.69, p <0.001). There was no sustained ventricular tachycardia, ventricular fibrillation, cardiac arrest, or death in either group. One uncomplicated acute myocardial infarction and 1 anaphylactoid reaction occurred in the CE group, and none occurred in the NCE group (p = 0.51). Rates of clinically significant arrhythmias were similar in both groups (CE 2.1% vs NCE 1.9%; p = 0.8). In conclusion, although CE of echocardiographic images was used more often in patients with a higher cardiac risk profile, the risk of major adverse events was very small in both the CE and NCE stress echocardiography cohorts.
authors.affiliation: Department of Cardiology, The Methodist Hospital and The Methodist DeBakey Heart and Vascular Center Imaging Institute, Houston, TX, USA.
authors.forename: Kamran
authors.initials: K
authors.lastname: Shaikh
authors.forename: Su Min
authors.initials: SM
authors.lastname: Chang
authors.forename: Leif
authors.initials: L
authors.lastname: Peterson
authors.forename: Kathleen
authors.initials: K
authors.lastname: Rosendahl-Garcia
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Quinones
authors.forename: Sherif F
authors.initials: SF
authors.lastname: Nagueh
authors.forename: Karla
authors.initials: K
authors.lastname: Kurrelmeyer
authors.forename: William A
authors.initials: WA
authors.lastname: Zoghbi
mesh_terms: D000368:Aged; D003287:Contrast Media / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D004280:Dobutamine / Q000009:adverse effects*; D025401:Echocardiography, Stress / Q000009:adverse effects*; D004699:Endocardium / Q000000981:diagnostic imaging*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013318:Stroke Volume; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media; D004280:Dobutamine