Abstract 10983: Should Use of Perflutren-based Echocardiographic Ultrasound Agents be Contraindicated in Patients With Intracardiac Shunts?
Background: The use of perflutren-based echocardiographic contrast agents (ECA) is contraindicated in patients with right-to-left or bidirectional intracardiac shunts (ICS) due to concerns related to neurological complications/systemic embolism. There is, however, no definitive evidence demonstrating harm or safety concerns from ECA use in patients with ICS.
Methods: A retrospective cohort study was conducted to evaluate association of ECA use and adverse events (AE) in patients with ICS compared to those without ICS, using the echocardiography database at Hennepin County Medical Center (Minneapolis, MN). ICS were identified by agitated 50% dextrose or normal saline. All studies with Definity (D) (Lantheus Medical Imaging, MA) and Optison (O) (GE Healthcare, NJ) were identified. Per lab protocol, ECA was not used in patients with cyanotic congenital heart disease. Electronic documentation of all AE reported by lab personnel was reviewed. A 30-minute interval after ECA administration was chosen for analysis. Primary AE was defined as a neurological event (stroke/TIA) or systemic embolism. Secondary AE (angioedema, bronchospasm, hypotension, hypoxemia, low back/lumbar pain, urticaria) were also reviewed. For patients with AE, individual electronic charts were reviewed. Fisher’s exact test was used to examine the difference in patients experiencing primary and secondary AE.
Results: From February 1, 1998 - November 30, 2012, 39,020 echocardiograms were performed using ECA (D=34,598; O=4,422). An ICS was identified in 481 patients; 38,539 patients comprised the non-ICS group. There were 0 primary AE in ICS group, and 1 primary AE in non-ICS group (p=0.99), with an estimated power to detect a difference of 0.85. There was 1 secondary AE in ICS group, and 34 secondary AE in non-ICS group (p=0.35). All AE occurred in studies using Definity (vs. Optison; p=0.028).
Conclusion: ECA use in patients with ICS (without cyanotic congenital heart disease) was not associated with adverse neurological events/systemic embolism. Our data indicate that current proscription of ECA use in patients with ICS should be rescinded.
- © 2013 by American Heart Association, Inc.