Arq Bras Cardiol: Imagem cardiovasc. 2023; 36(2): e20230033

Contrast Echocardiography in Real Life: Practicality, Safety, and Cost-Effectiveness

Márcio Silva Miguel

Lima

DOI: 10.36660/abcimg.20230033i

After approximately 2 decades of use in practice, based also on several clinical studies, it can be stated that ultrasound enhancing agents (UEA) are extremely safe, following recommendations for their preparation and administration.^– Severe adverse events are very rare, with an approximate prevalence of around 1 in every 10,000 administrations, anaphylactoid reactions being the most frequent.^,- Specifically with the contrast SonoVue® (sulfur hexafluoride) used in Brazil, Furtado, Rassi, et al., in their safety study, reported a very low incidence of only 0.6% of allergic reaction in their population of 1,099 patients who received this agent. In general, allergic reactions occur immediately or within 30 minutes after administration; they are of mild intensity and transitory. The most common presentation is the appearance of erythematous skin lesions and urticaria. In this scenario, however, special attention should be paid to respiratory signs and symptoms, such as dyspnea, laryngeal stridor, and bronchospasm, as well as signs and symptoms of progression to eventual circulatory collapse, such as dizziness, paleness, and hypotension, as these are warning signs for the onset of anaphylactic shock. Patients must be carefully evaluated and observed, and measures aimed at anaphylaxis should be promptly instituted with antihistamines, corticosteroids, and epinephrine, following the care protocol of the institution, whose personnel must be very well trained.

In October 2007, the United States Food and Drug Administration (FDA) issued a general contraindication (“black box”) for the use of Definity® and Optison® agents in acutely ill patients after analysis of 11 deaths potentially related to the use of these UEA. This restriction was later withdrawn after subsequent clinical studies provided extensive evidence of safety. Advanced pulmonary disease and pulmonary hypertension initially represented contraindications, but clinical trials confirmed their safety.^– Additionally, in relation to the suspicion or presence of significant intracardiac shunt, also a previous contraindication, it was suspended by the FDA in 2016.^, Currently, only history of allergic reaction to any component of UEA constitutes an absolute contraindication to their use.

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