Administration of perflutren contrast agents during transthoracic echocardiography is not associated with a significant increase in acute mortality risk.
BACKGROUND
Despite the 2008 revision of a previously issued black box warning of the US Food and Drug Administration against the use of perflutren ultrasound contrast agents, the warning still reports fatalities having occurred following their administration. We sought to assess 1-day mortality associated with contrast use across a wide range of clinical settings and co-morbidities.


METHODS
We conducted a retrospective study involving 96,705 transthoracic echocardiograms (TTE) in 63,189 adults at our institution between July 2003 and June 2008. A contrast agent was used in 2,518 TTE during this time. The primary outcome was total mortality within 1 day of TTE.


RESULTS
Death occurred in 10 patients (0.44%) in the contrast group and in 421 patients (0.69%) in the non-contrast group (p = 0.14). In a multivariate model, use of contrast enhancement was not associated with increased mortality (p = 0.67) after adjustment for age, gender, race, patient location, ejection fraction, and the presence of various co-morbidities. Cause of death analysis did not identify any cases where contrast played a likely role.


CONCLUSIONS
Definity contrast use during TTE was not associated with increased acute mortality risk. Contrast administration during TTE should not be withheld when the additional information obtained could potentially improve patient management.
Albert Einstein College of Medicine, Bronx, NY 10467, USA. ygoldber@montefiore.org
Ythan H
YH
Goldberg
Paul
P
Ginelli
Robert
R
Siegel
Robert J
RJ
Ostfeld
Michael
M
Schaefer
Daniel M
DM
Spevack
D000368:Aged; D002423:Cause of Death; D003287:Contrast Media / Q000009:adverse effects*; D004452:Echocardiography / Q000009:adverse effects / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D005466:Fluorocarbons / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
D003287:Contrast Media; D005466:Fluorocarbons; C042852:perflutren