Safety of Ultrasound Contrast Agents in Patients With Known or Suspected Cardiac Shunts

Contrast-enhanced ultrasound imaging is a radiation-free diagnostic tool that uses biocompatible ultrasound contrast agents (UCAs) to improve image clarity. UCAs, which do not contain dye, often salvage “technically difficult” ultrasound scans, increasing the accuracy and reliability of a front-line...

Full description

Saved in:
Bibliographic Details
Published in:The American journal of cardiology 2013-10, Vol.112 (7), p.1039-1045
Main Authors: Parker, Jeremy M., MD, Weller, Mark W., JD, Feinstein, Linda Maiman, JD, Adams, Robin J., BS, Main, Michael L., MD, Grayburn, Paul A., MD, Cosgrove, David O., MD, Goldberg, Barry A., MD, Darge, Kassa, MD, PhD, Nihoyannopoulos, Petros, MD, Wilson, Stephanie, MD, Monaghan, Mark, PhD, Piscaglia, Fabio, MD, Fowlkes, Brian, PhD, Mathias, Wilson, MD, Moriyasu, Fuminari, MD, PhD, Chammas, Maria Christina, MD, PhD, Greenbaum, Lennard, MD, Feinstein, Steven B., MD
Format: Article
Language:English
Subjects:
Albumins - adverse effects
Cardiovascular
Clinical medicine
Confidence intervals
Contraindications
Contrast agents
Contrast Media - adverse effects
Echocardiography - methods
Fluorocarbons - adverse effects
Gases
Heart attacks
Heart Diseases - diagnostic imaging
Hospitalization
Humans
Medical imaging
Molecular weight
Mortality
Pediatrics
Pulmonary arteries
Ultrasonic imaging
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Contrast-enhanced ultrasound imaging is a radiation-free diagnostic tool that uses biocompatible ultrasound contrast agents (UCAs) to improve image clarity. UCAs, which do not contain dye, often salvage “technically difficult” ultrasound scans, increasing the accuracy and reliability of a front-line ultrasound diagnosis, reducing unnecessary downstream testing, lowering overall health care costs, changing therapy, and improving patient care. Two UCAs currently are approved and regulated by the US Food and Drug Administration. They have favorable safety profiles and risk/benefit ratios in adult and pediatric populations, including compromised patients with severe cardiovascular diseases. Nevertheless, these UCAs are contraindicated in patients with known or suspected right-to-left, bidirectional, or transient right-to-left cardiac shunts. These patients, who constitute 10% to 35% of the general population, typically receive no UCAs when they undergo echocardiography. If their echocardiographic images are suboptimal, they may receive inappropriate diagnosis and treatment, or they may be referred for additional diagnostic testing, including radiation-based procedures that increase their lifetime risk for cancer or procedures that use contrast agents containing dye, which may increase the risk for kidney damage. An exhaustive review of current peer-reviewed research demonstrated no scientific basis for the UCA contraindication in patients with known or suspected cardiac shunts. Initial safety concerns were based on limited rodent data and speculation related to macroaggregated albumin microspheres, a radioactive nuclear imaging agent with different physical and chemical properties and no relation to UCAs. Radioactive macroaggregated albumin is not contraindicated in adult or pediatric patients with cardiac shunts and is routinely used in these populations. In conclusion, the International Contrast Ultrasound Society Board recommends removal of the contraindication to further the public interest in safe, reliable, radiation-free diagnostic imaging options for patients with known or suspected cardiac shunts and to reduce their need for unnecessary downstream testing.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2013.05.042