Diagnostic accuracy and cost-effectiveness of contrast echocardiography on evaluation of cardiac function in technically very difficult patients in the intensive care unit

Administration of Perflutren Contrast Agents during Transthoracic Echocardiography Is Not Associated with a Significant Increase in Acute Mortality Risk

“…The patients who died after contrast TTE in both the FDA report and in our study had high mortality risk prior to TTE, and our results indicate that their deaths were likely unrelated to their contrast TTE. Thus, contrast should continue to be used to improve diagnostic capabilities of TTE, even in acutely ill patients and during stress testing, where it has proven to be of benefit [3,8,9,10,11]. …”

“…This additional information provided by contrast agents often results in a change in patient management [5]. The use of contrast enhancement has also been shown to reduce interobserver variability in estimating ejection fraction [6,7], improve diagnostic value of dobutamine stress echocardiography in patients with poor acoustic windows [8,9], and enhance data acquisition in intensive care unit (ICU) patients with technically difficult studies [10,11]. …”

Overview of the 2008 Food and Drug Administration Advisory Committee on Safety Considerations in the Development of Ultrasound Contrast Agents

“…Because a nondiagnostic echocardiogram needs to be followed by another imaging modality (transesophageal echocardiogram, nuclear stress test, cardiac MRI, catheterization, etc), the cost is significantly higher if no contrast is used. [11][12][13] Additional imaging modalities add substantial expensive and carry a higher risk than the injection of contrast.…”

Safety of ultrasound contrast agents: 'Primum non nocere'?

“…Although UCA have proven utility in the diagnosis and management of critically ill patients [41][42][43][44] , concern persists regarding the safety of these compounds, particularly in these patients. Recently published single-centre data demonstrated no increased mortality in hospitalized patients undergoing echocardiography with UCA in comparison with patients undergoing noncontrast-enhanced examinations 45 .…”

“…On the other hand, UCA frequently result in the diagnosis of LV apical thrombus in AMI, which is a major risk factor for death or stroke 52 . In other circumstances, the addition of contrast agents results in potentially lifesaving changes in therapy especially in critically ill patients with hypotension, heart failure, or respiratory failure 43,44 . Therefore, in most of these circumstances, the benefit of UCA far outweighs their risks.…”