JACC: No increased risk of contrast-related death with stress echo

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The use of contrast agents during stress echocardiography does not lead to short- or long-term risk of death or myocardial infarction (MI), according to a study in the September issue of the Journal of the American College of Cardiology: Cardiovascular Imaging.

Researchers at the Mayo Clinic in Rochester, Minn. studied 26,774 patients who underwent stress echo between Nov. 1, 2003 and Dec. 31, 2007. The contrast cohort (10,792 patients) received second-generation perfluorocarbon-based agents for left ventricular opacification. The non-contrast cohort (15,982 patients) had stress echo without contrast.

Lead author Sahar Abdelmoneim, MD, from the division of cardiovascular diseases at Mayo Clinic in Rochester, Minn., and the division of cardiovascular diseases at Assiut University in Assiut, Egypt, and colleagues reported that patients in the contrast cohort had a greater risk of coronary artery disease than patients in the non-contrast group. Even though the group had higher-risk patients, the contrast cohort had percentages of deaths and MIs comparable to those of the non-contrast cohort.

In the short term, one patient in the contrast cohort died--a 76-year-old woman with diabetes mellitus who underwent dobutamine stress echo in a preoperative evaluation for repair of a mycotic aortic aneurysm. According to the authors, stress echo results were normal, with no reported adverse effects from contrast agents. The patient died of cardiac and multiorgan failures 48 hours after the stress echo. Within 72 hours of stress echo, three patients in the contrast cohort and seven in the non-contrast cohort had MI.

Within 30 days of stress echo, 37 patients in the contrast cohort died, while there were 57 deaths among patients in the noncontrast cohort.

According to the authors, ventricular tachycardia (VT) occurred in 11 patients in the contrast cohort and in seven patients in the noncontrast cohort. In the contrast cohort, two patients had sustained VT, two had ventricular fibrillation and seven had nonsustained VT. In the noncontrast cohort, two patients had sustained VT and five had nonsustained VT.

Over the long term, of the 10,792 patients in the contrast cohort, 841 patients had an event in the follow up. The authors reported that 658 patients died and 183 had MI. Of the 15,982 in the noncontrast group, 1,247 had events during follow-up, with 978 deaths and 269 who had MI.

The researchers concluded that during short- and long-term follow-up patients who underwent stress echo with contrast agents were not at risk of death of MI compared with patients who had not received contrast—even though those patients who required contrast had a greater risk of coronary artery disease. In addition, the researchers found that side effects associated with contrast agents were minor and infrequent.