Safety of contrast administration for endocardial enhancement during stress echocardiography compared with...

The aim was to evaluate the safety of stress echocardiography using contrast (CE) for endocardial enhancement compared with a noncontrast (NCE) cohort in a large nonselect population. The recent Food and Drug Administration warning cited lack of data for safety regarding the use of contrast in conjunction with stress echocardiography. A detailed record review was performed for 5,069 consecutive patients who underwent stress echocardiography (58% pharmacologic, 42% exercise) during an 8-year period. Contrast use, hemodynamics, and adverse clinical and electrocardiographic events were evaluated until time of discharge from the laboratory. Contrast was administered to 2,914 patients (58%) and was higher in in-patients (66%) and during dobutamine stress (67%). Compared with the NCE group, the CE group was older (median age 61 vs 58 years) and had more depressed left ventricular ejection fraction <50% (14% vs 11%; all p <0.001). The CE group experienced more chest pain (11% vs 8%; p = 0.001), back pain (0.6% vs 0.05%; p <0.001), and premature ventricular contractions (odds ratio 1.42, 95% confidence interval 1.19 to 1.69, p <0.001). There was no sustained ventricular tachycardia, ventricular fibrillation, cardiac arrest, or death in either group. One uncomplicated acute myocardial infarction and 1 anaphylactoid reaction occurred in the CE group, and none occurred in the NCE group (p = 0.51). Rates of clinically significant arrhythmias were similar in both groups (CE 2.1% vs NCE 1.9%; p = 0.8). In conclusion, although CE of echocardiographic images was used more often in patients with a higher cardiac risk profile, the risk of major adverse events was very small in both the CE and NCE stress echocardiography cohorts.