The use of transpulmonary contrast echocardiography – a first experience in Serbia

Anastazija Stojšić-Milosavljević; Aleksandra Ilić; Snežana Stojšić; Vladimir Ivanović; Jelena Milićević; Robert Kovač; Maja Stefanović; Snežana Tadić; Tatjana Miljković; Marija Bjelobrk; Dragana Dabović; Dragoslava Živkov-Šaponja; Milovan Petrović; Aleksandar Redžek

doi:10.2298/VSP190127020S

Anastazija Stojšić-Milosavljević University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Aleksandra Ilić University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Snežana Stojšić Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
Vladimir Ivanović University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Jelena Milićević University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Robert Kovač Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
Maja Stefanović University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Snežana Tadić University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Tatjana Miljković University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Marija Bjelobrk University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Dragana Dabović University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Dragoslava Živkov-Šaponja Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
Milovan Petrović University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Aleksandar Redžek University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia

DOI: https://doi.org/10.2298/VSP190127020S

Keywords: adverse drug reaction reporting systems, cardiovascular diseases, comorbidity, contrast media, echocardiography

Abstract

Background/Aim. Contrast echocardiography (CE) is an echocardiographic modality where ultrasound contrast echocardiographic agent (CEA) is introduced peripherally for the image enhancement. The aim of this study was to present the initial clinical experience of the use of CEA Optison^™ (GE Healthcare, Princeton, NJ) at the Institute for Cardiovascular Diseases of Vojvodina, Serbia and prospectively monitor the occurrence of possible side effects. Methods. A total of 357 patients were referred for resting or stress echocardiographic examinations, with an approved indication for CEA administration. The average age of patients was 63.3 years (range, 21–92 years), 62% of them were men. Most of the patients (77.31%) had some form of ischemic heart diseases. Hypertension was the most frequent risk factor (77.03%), but 57 patients had diabetes mellitus and 33 patients had chronic kidney disease as comorbidity. Most (90.5%) of the patients were on beta blocker therapy, 83.5% of them on angiotensin converting enzyme/angiotensin receptor blockers. Majority (80.3%) of the patients received single or dual (49.5%) antiagregation therapy, 74 (26.3%), of them were on anticoagulation therapy, 55.1% of the patients were taking diuretics. The global ejection fraction (EF) was preserved in 39.85% of them, the majority (136 of them), had left ventricle (LV) impairment, with an EF less than 50%. Patients were followed up for 30 minutes after CEA administration for potential side effects. In 118 patients, vital signs (heart rate, oxygen saturation, body temperature, systolic and diastolic blood pressure) were measured before and 30 minutes after CEA administration. Results. The administration of CEA was not associated with side effects. Diastolic blood pressure drop and heart rate increase were statistically, but not clinically significant (p = 0.027 and p = 0.028, respectively). Conclusion. Changes in analyzed vital signs were clinically non relevant. CE is a safe noninvasive diagnostic modality for patients undergoing rest and stress echocardiography.

References

Porter TR, Mulvagh SL, Abdelmoneim SS, Becher H, Belcik JT, Bierig M, et al. Clinical application of ultrasonic enhancing agents in echocardiography: 2018 American Society of Echocardiography Guidelines Update. J Am Soc Echocardiogr 2018; 31(3): 241−74.

Senior R, Becher H, Monaghan P, Agati L, Zamorano J, Vanoverschelde J, et al. Clinical practice of contrast echocardiography: recommendation by the European Association of Cardiovascular Imaging (EACVI)2017. Eur Heart J Cardiovasc Imaging 2017; 18(11): 1205−1205af.

GE Healthcare. OPTISON Prescribing Information. http://www.optisonimaging. Available from: com/us/wp-content/uploads/2013/10/optison_pi.pdf

Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, et al. ESC guidelines on the management of stable coronary artery disease. Eur Heart J 2013; 34(38): 2949−3003.

Douglas PS, Weyman AE, Lindner JR, Wei K. Contrast echocardiography: past, present, and future? JACC Cardiovasc Imaging 2008; 1(1):107–10.

Wever-Pinzon O, Suma V, Ahuja A, Romero J, Sareen N, Henry SA, et al. Safety of echocardiographic contrast in hospitalized patients with pulmonary hypertension: a multi-center study. Eur Heart J Cardiovasc Imag 2012; 13(10): 857–62.

Goldberg YH, Ginelli P, Siegel R, Ostfeld RJ, Schaefer M, Spevack DM. Administration of perflutren contrast agents during transthoracic echocardiography is not associated with a significant increase in acute mortality risk. Cardiology 2012; 122(2): 119–25.

Platts DG, Luis SA, Roper D, Burstow D, Call T, Forshaw A, et al. The safety profile of perflutren microsphere contrast echocardiography during rest and stress imaging: results from an Australian multicentre cohort. Heart Lung Circ 2013; 22(12): 996–1002.

Saric M, Armour A, Arnaoutet S, Chaudhry F, Grimm RA, Kronzon I, et al. Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism. J Am Soc Echocardiogr 2016; 29(1): 1−42.

van der Meer SM. Ultrasound Contrast Agents: Resonances of Coated Bubbles. [thesis]. ‎Enschede, Netherlands: University of Twente; 2007.

Shah BN, Chahal NS, Bhattacharyya S, Li W, Roussin I, Khattar RS, et al. The feasibility and clinical utility of myocardial contrast echocardiography in clinical practice: results from the incorporation of myocardial perfusion assessment into clinical testing with stress echocardiography study. J Am Soc Echocardiogr 2014; 27(5): 520–30.

Stojšić-Milosavljević A. Importance of contrast echocardiography in left ventricle parietal thrombus. Novi Sad: Faculty of Medicine, University of Novi Sad; 2015. (Serbian)

EMA, Assessment Report 2 May 2014, SonoVue Procedure No. EMEA/H/C/000303/II/0025. Available from: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Assessment_Report_-_Variation/human/000303/WC500170218.pdf> [accessed 2014 December 16].

Wei K, Mulvagh SL, Carson L, Davidoff R, Gabriel R, Grimm RA, et al. The safety of Definity and Optison for ultrasound image enhancement: a retrospective analysis of 78,383 administered contrast doses. J Am Soc Echocardiogr 2008; 21(11): 1202−6.

Exuzides A, Main ML, Colby C, Grayburn PA, Feinstein SB, Goldman JH. A restrospective comparison of mortality in critically ill hospitalized patients undergoing echocardiography with and without an ultrasound contrast agent. JACC Cardiovasc Imaging 2010; 3(6): 578−85.

Porter TR, Abdelmoneim S, Belcik JT, McCulloch ML, Mulvagh SL, Olson JJ, et al. Guidelines for the cardiac sonographer in the performance of contrast echocardiography: a focused update from the American Society of Echocardiography. J Am Soc Echocardiogr 2014; 27(8): 797–810.

Mulvagh SL, Rakowski H, Vannan MA, Abdelmoneim SS, Becher H, Bierig SM, et al. American Society of Echocardiography consensus statement on the clinical applications of ultrasonic contrast agents in echocardiography. J Am Soc Echocardiogr 2008; 21(11): 1179−201; quiz 1281.

Knuuti J, WijnsW, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020; 41(3): 407−77.

Hoffmann R, von Bardeleben S, Barletta G, Pasques A, Kasprzak J, Greis C, et al Comparison of two- and three-dimensional unenhanced and contrast-enhanced echocardiographies versus cineventriculography versus cardiac magnetic resonance for determination of left ventricular function. Am J Cardiol 2014; 113(2): 395−401.

Galiuto L, Garramone B, Scarà A, Rebuzzi AG, Crea F, La Torre G, et al. The extent of microvascular damage during myocardial contrast echocardiography is superior to other known indexes of post-infarct reperfusion in predicting left ventricular remodeling results of the multicenter AMICI Study. J Am Coll Cardiol 2008; 51(5): 552−9.

Hoffmann R, Barletta G, von Bardeleben S, Vanoverschelde JL, Kasprzak J, Greis C, et al. Analysis of left ventricular volumes and function–a multicenter comparison of cineventriculography, cardiac magnetic resonance imaging, unenhanced and contrast enhanced 2D and 3D echocardiography. J Am Soc Echocardiogr 2014; 27(3): 292−301.

Hoffmann R, von Bardeleben S, ten Cate R, Borges AS, Kasprzak J, Firschke C, et al. Assessment of systolic left ventricular function: a multi-centre comparison of cineventriculography, cardiac magnetic resonance imaging, unenhanced and contrast-enhanced echocardiography. Eur Heart J 2005; 26(6): 607−16.

Mansencal N, Nasr IA, Pillière R, Farcot JC, Joseph T, Lacombe P, et al. Usefulness of contrast echocardiography for assesment of lft ventriclular thrombus after acute myocardial infarction. Am J Cardiol 2007; 99(12): 1667−70.

Kirkpatrick JN, Wong T, Bednarz JE, Spencer KT, Sugeng L, Ward RP, et al. Differential diagnosis of cardiac masses using contrast echocardiographic perfusion imaging. J Am Coll Cardiol 2004; 43(8): 1412−9.

Staab W, Bergau L, Schuster A, Hinojar R, Dorenkamp M, Obenauer S, et al. Detection of intracardiac masses in patients with coronary artery disease using cardiac magnetic resonance imaging: a comparison with transthoracic echocardiography. Int J Cardiovasc Imaging 2014; 30(3): 647−57.

Kurt M, Shaikh KA, Peterson L, Kurrelmeyer KM, Shah G, Nagueh SF, et al. Impact of contrast echocardiography on evaluation of ventricular function and clinical management in a large prospective cohort. J Am Coll Cardiol 2009; 53(9): 802−10.

Gaibazzi N, Rigo F, Reverberi C. Detection of Coronary Artery Disease by Combined Assessment of Wall Motion, Myocardial Perfusion and Coronary Flow Reserve: A Multiparametric Contrast Stress-Echocardiography Study. J Am Soc Echocardiogr 2010; 23(12): 1242−50.

Nayyar S, Magalski A, Khumri TM, Idupulapati M, Stoner CN, Kusnetzky LL, et al. Contrast administration reduces interobserver variability in determination of left ventricular ejection fraction in patients with left ventricular dysfunction and good baseline endocardial border delineation. Am J Cardiol 2006; 98(8): 1110–4.

Pellikka P, Arruda-Olson A, Chaudhry F, Chen M, Marshall J, Porter T, et al. Guidelines for performance, interpretation, and application of stress echocardiography in ischemic heart disease: from the American Society of Echocardiography. J Am Soc Echocardiogr 2020; 33(1): 1−41.e8.

Mladenovic Z, Djordjevic -Dikic A, Djuric P, Angelkov Ristic A, Dzudovic B, Jovic Z. Diagnostic value of noninvasive comprehensive morphological and functional assesment of coronary artery disease. Vojnosanitet Pregl 2019; 76(2): 136−43.

Grayburn PA. Product safety compromises patient safety (an unjustified black box warning on ultrasound contrast agents by the Food and Drug Administration). Am J Cardiol 2008; 101(6): 892–3.

Main ML. Ultrasound contrast agent safety: from anecdote to evidence. JACC Cardiovasc Imaging 2009; 2(9): 1057–9.

Cohen L, Cheirif J, Segar D, Gillam L, Gottdiener J, Hausnerova E, et al. Improved left ventricular endocardial border delineation and opacification with OPTISON (FS069), a new echocardiographic contrast agent results of a phase III multicenter trial. J Am Coll Cardiol 1998; 32(3): 746–52.

Porter TR, Smith LM, Wu J, Thomas D, Haas JT, Mathers DH, et al. Patient outcome following 2 different stress imaging approaches: a prospective randomized comparison. J Am Coll Cardiol 2013; 61(24): 2446−55.

Parker JM, Weller MW, Feinstein LM, Adams RJ, Main ML, Grayburn PA, et al. Safety of ultrasound contrast agents in patients with known or suspected cardiac shunts. Am J Cardiol 2013; 112(7): 1039−45.

Emanuel AL, Meijer RI, van Poelgeest E, Spoor P, Serné EH, Eringa EC. Contrast‐enhanced ultrasound for quantification of tissue perfusion in humans. Microcirculation 2020; 27(1): e12588.

Senior R, Moreo A, Gaibazzi N, Agati L, Tiemann K, Shivalkar B, et al. Comparison of sulfur hexafluoride microbubble (SonoVue)-enhanced myocardial contrast echocardiography with gated single-photon emission computed tomography for detection of significant coronary artery disease: a large European multicenter study. J Am Coll Cardiol 2013; 62(15): 1353−61.

Main ML, Ryan AC, Davis TE, Albano MP, Kusnetzky LL, Hibberd M. Acute mortality in hospitalized patients undergoing echocardiography with and without an ultrasound contrast agent (multicenter registry results in 4,300,966 consecutive patients). Am J Cardiol 2008; 102(12): 1742−6.