CORRESPONDENCE: LETTERS TO THE EDITOR
Safety of Dobutamine Contrast Stress Echocardiography
Jonathan Timperley, MB, ChB, MRCP* and
Harald Becher, MD, PhD
* Department of Cardiology, John Radcliffe Hospital, Headington, Oxford OX3 9DU, United Kingdom (Email: jon.timperley{at}orh.nhs.uk).
We agree with Tsutsui et al. (1) that dobutamine real-time contrast echocardiography is both a safe and feasible technique. Sonovue (Bracco Imaging, Milan, Italy) is commonly used in Europe for left ventricular opacification, although it is not approved by the U.S. Food and Drug Administration (2). In Europe, the summary of product characteristics of Sonovue was changed following safety concerns in patients with significant coronary artery disease (CAD). We have previously published similar findings to those of Tsutsui et al. (3) from our experience using both Sonovue and Optison during dobutamine stress echocardiography in over 400 patients and low mechanical index real-time imaging. Specifically, we found no increased incidence of arrhythmia, ectopy, hypotension, or other side effects, and once again no mortality or myocardial infarctions.
The data from Tsutsui et al. (1) and also our center should reassure echocardiographers of the safety of contrast agents during dobutamine stress. It is also important to remember that up to 30% of echocardiograms may be nondiagnostic owing to poor image quality, and there are implications for both false positive and false negative results. A false negative result may lead to false reassurance to a patient with significant CAD, whereas a false positive test or nondiagnostic test may lead to further noninvasive or invasive imaging. Other noninvasive tests are not without small but definite risks. The mortality from single-photon emission computed tomography is reported at 0.05% (4), and the mortality from coronary angiography is 0.03% to 0.26% (5) as well as other peripheral vascular and cerebrovascular morbidities. It is therefore important that image quality during dobutamine stress echocardiography is not sacrificed and the use of contrast appears safe, feasible, and effective.
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References
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- Tsutsui JM, Elhendy A, Xie F, O’Leary EL, McGrain AC, Porter TR. Safety of dobutamine stress real-time myocardial contrast echocardiography J Am Coll Cardiol 2005;45:1235-1242.[Abstract/Free Full Text]
- The European Agency for the Evaluation of Medicinal Products. Public statement on Sonovue (sulphur hexafluoride). New contraindication in patients with heart disease. Restriction of use to non-cardiac imaging, 2004. Available at: http://www.emea.eu.int/pdfs/human/press/pus/021204en.pdf. Accessed September 28, 2005..
- Timperley J, Mitchell AR, Thibault H, Mirza IH, Becher H. Safety of contrast dobutamine stress echocardiographya single-center experience. J Am Soc Echocardiogr 2005;18:163-167.[CrossRef][ISI][Medline]
- Ranhosky A, Kempthorne-Rawson J. The safety of intravenous dipyridamole thallium myocardial perfusion imaging. Intravenous Dipyridamole Thallium Imaging study group Circulation 1990;81:1205-1209.[Abstract/Free Full Text]
- Pepine CJ. Diagnostic and therapeutic cardiac catheterizationBaltimore: Lippincott: Williams & Wilkins; 19891066.
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