Document Detail

Safety of contrast agent use during stress echocardiography in patients with elevated right ventricular systolic pressure: a cohort study.
MedLine Citation:
PMID:  20233859     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Microbubble safety concerns led to changes in product recommendations for patients with pulmonary hypertension. Noninvasive estimation of right ventricular systolic pressure (RVSP) is equivalent to pulmonary artery systolic pressure in the absence of pulmonary outflow obstruction. We analyzed the short- and long-term outcomes of patients who received microbubble contrast and those who did not during stress echocardiography (SE) according to resting RVSP. METHODS AND RESULTS: From November 2003 to December 2007, 26,774 patients underwent SE. RVSP (mean, 32.6+/-9.6 mm Hg) was measured in 16 434 patients. Of these, 6164 (37.5%) received contrast for left ventricular opacification and 10 270 (62.5%) did not. Short-term (< or =72 hours and < or =30 days) and long-term (4.3 years) end points were death and myocardial infarction. Analysis was done for rest RVSP cut-points > or =35, > or =50, and > or =60 mm Hg and tricuspid regurgitant velocities > or =2.7 ms(-1) and > or =3.5 ms(-1). Adjusted Cox regression models were used. The contrast cohort comprised older patients (age, 67+/-12 versus 64+/-14 years; P<0.001), who were more likely to have positive SE results (35% versus 30%, P<0.001) compared with the noncontrast cohort. Using RVSP > or =50 mm Hg, there was no significant difference in short-term events between the contrast and noncontrast cohorts. For long-term events, there was no significant difference between both cohorts (adjusted hazard ratios [95% confidence intervals] for death, 1.10 [0.80 to 1.50], P=0.56; and myocardial infarction, 0.34 [0.11 to 1.03], P=0.06). Similar results were obtained at different RVSP and tricuspid regurgitant cut-points. Contrast agent-related adverse effects occurred in <1% of patients. CONCLUSIONS: RVSP had no impact on predisposition to adverse outcomes in patients undergoing contrast SE in the population studied.
Sahar S Abdelmoneim; Mathieu Bernier; Christopher G Scott; Abhijeet Dhoble; Sue Ann C Ness; Mary E Hagen; Stuart Moir; Robert B McCully; Patricia A Pellikka; Sharon L Mulvagh
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-03-16
Journal Detail:
Title:  Circulation. Cardiovascular imaging     Volume:  3     ISSN:  1942-0080     ISO Abbreviation:  Circ Cardiovasc Imaging     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-20     Completed Date:  2010-06-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101479935     Medline TA:  Circ Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  240-8     Citation Subset:  IM    
Division of Cardiovascular Diseases and the Division of Biostatistics Mayo Clinic, Rochester, MN 55905, USA.
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MeSH Terms
Albumins / adverse effects,  diagnostic use
Arrhythmias, Cardiac / complications,  physiopathology
Blood Pressure
Cohort Studies
Contrast Media / adverse effects*,  diagnostic use
Echocardiography, Doppler, Color / methods
Echocardiography, Stress / methods*
Feasibility Studies
Fluorocarbons / adverse effects,  diagnostic use
Hypertension, Pulmonary / complications,  physiopathology,  ultrasonography*
Image Enhancement / methods
Middle Aged
Myocardial Infarction / complications,  etiology*,  mortality
Retrospective Studies
Survival Analysis
Tricuspid Valve / ultrasonography
Tricuspid Valve Insufficiency / physiopathology,  ultrasonography
Ventricular Dysfunction, Right / complications,  physiopathology,  ultrasonography*
Reg. No./Substance:
0/Albumins; 0/Contrast Media; 0/Definity; 0/FS 069; 0/Fluorocarbons

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