New Study Affirms Safety of Cardiac Ultrasound Contrast Agents Despite Previous Concerns

A comprehensive new analysis challenges earlier reports suggesting that ultrasound enhancing agents (UEAs) used in transthoracic or stress echocardiography (TTE/SE) may pose heightened safety risks to patients. While UEAs are known to significantly improve echocardiography assessments by enhancing visualization of the endocardial border, concerns had arisen over a recent increase in adverse reactions associated with their use in TTE/SE exams.

However, previous studies have produced conflicting results regarding the risk of such reactions. Dr. Jordan B. Strom, from the Cardiovascular Division at Beth Israel Deaconess Medical Center in Boston, and his colleagues noted, “Pharmacovigilance reporting several years ago suggested that one possible explanation for these rare allergic reactions may be related to the polyethylene glycol component found in certain UEAs but did not find that the rate of reactions had increased.” They further stated, “However, a recent report described an increase in severe allergic reactions to UEAs, further suggesting that the risk of severe and critical adverse drug reactions may differ by agent and may be related to history of prior receipt of COVID‐19 vaccination.”

To obtain a clearer understanding of the actual rate of adverse events linked to UEAs, the research team analyzed data from millions of patients, including over 500,000 who received a UEA during their stress test. Within two days post-examination, the incidence of adverse events was lower in the group that received contrast agents compared to those who did not, at 0.02% versus 0.14%. These findings were consistent across three commonly used cardiac contrast agents—Definity, Lumason, and Optison—and remained stable throughout the years studied, both before and after the COVID-19 pandemic.

The authors concluded, “Overall, these findings suggest the continued safety profile of UEAs in contemporary practice.” They added, “Moreover, they suggest that safety differences between agents should be contextualized by the setting of administration, the comorbidities of those receiving UEAs, and the route/manner of administration.”