Safety of myocardial flash-contrast echocardiography in combination with dobutamine stress testing for detection of ischemia in 5250 studies

¹ 1st Cardiology Department, School of Medicine, University of Athens, Hippokration Hospital, Greece, Greece

^* To whom correspondence should be addressed. E-mail: caggeli{at}otenet.gr.

Accepted 25 March 2008

	Abstract

Objective The purpose of the present study was to provide evidence regarding the safety of real-time flash-contrast echocardiography combined with dobutamine-atropine stress echo (DASE).

Background The combination of perfusion assessment using myocardial contrast echocardiography (MCE) with DASE has shown very promising results for the diagnosis of coronary artery disease. However, concerns have been expressed regarding the safety of the use of echo-contrast agents in echocardiography.

Design 5250 individuals (70.8% male, aged 64.6,,b10.6) were submitted to DASE, with concurrent MCE using a low-mechanical-index technique with administration of high-energy impulses in order to assess replenishment time.

Results No deaths or myocardial infarctions were observed. Sustained ventricular tachycardia (VT) or fibrillation requiring resuscitation occurred in two cases (0.04%). The incidence of other arrhythmic events was: sustained VT not requiring resuscitation GBP P=10 (0.18%), non-sustained VT £P=18 (0.34%), atrial tachycardia GBP P=4 (0.08%), atrial fibrillation GBP P=25 (0.48%). Other observed adverse events included: Intense headache GBP P=52 (1%), intense back-pain GBP P=26 (0.5%). Vagal reactions with marked systolic blood pressure fall were observed in 45 cases (0.9%). Hypersensitivity reactions were reported in 23 cases (0.44%), while no serious cases of hypersensitivity requiring hospitalization were recorded. The sensitivity, specificity and overall accuracy of DASE/MCE were 92%, 61%, 85%, respectively.

Conclusions We report safety data regarding stress-contrast echocardiography in a large series of subjects, suggesting that this is an exceptionally safe technique, given that in 5250 studies no study-related deaths or myocardial infarctions were encountered, while serious adverse events requiring hospitalization were extremely rare (1 in 2625 studies).