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European Journal of Echocardiography Advance Access published online on June 6, 2009
European Journal of Echocardiography, doi:10.1093/ejechocard/jep078
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Safety of contrast flash-replenishment stress echocardiography in 500 patients with a chest pain episode of undetermined origin within the last 5 days

Nicola Gaibazzi*, Angelo Squeri, Diego Ardissino and Claudio Reverberi

Heart Centre, Parma University Hospital, Parma, Italy

Received 11 March 2009; accepted after revision 16 May 2009.

* Corresponding author: Azienda Ospedaliero, Dipartimento Cardiopolmonare, Universitaria di Parma, U.O.Cardiologia, Via Gramsci, 14-43100 Parma, Italy. Tel: +39 052 196 7914. E-mail address: nicola.gaibazzi{at}inwind.it


  Abstract

Aims: Safety concerns regarding the use of echo-contrast agents during baseline and SE in patients with recent chest pain have been raised. The purpose of the present study was to provide evidence regarding the safety of flash-replenishment contrast dipyridamole–atropine echocardiography (DASE) in such patients.

Methods and results: Five hundred consecutive individuals who presented to the Emergency Department with chest pain, normal electrocardiograms (ECG) and troponin I were selected based on a less than 5 days interval between chest pain episode and performance of contrast flash-replenishment DASE. Analysis of myocardial perfusion with SonoVue© infusion after dipyridamole was routinely added on top of standard wall motion assessment during DASE. Adverse events (AEs) were reported according to standardized terminology and then compared with a historical control group in which contrast was not used. No deaths, myocardial infarctions, sustained arrhythmias, or any other life-threatening events were observed. Adverse events were not significantly different between the study group and the control group. In the selected subgroup of patients (n = 149) who underwent coronary angiography, accuracy of DASE with additional perfusion assessment was higher (88%, 95% C.I. 83–93%) than without (72%, 95% C.I. 65–79%).

Conclusion: DASE with SonoVue© infusion for myocardial perfusion assessment was exceptionally safe even when routinely performed within the first 5 days following a chest pain episode of undetermined origin in subjects without ECG and troponin abnormalities.

Keywords: Stress echocardiography; Dipyridamole; Chest pain; SonoVue; Contrast media


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