TTE with contrast yielded lower mortality than non-contrast TTE in critically ill patients

Main M. J Am Coll Cardiol Img. 2013;doi:10.1016/j.jcmg.2013.08.012.

  • December 20, 2013

A recent study has demonstrated that echocardiography with a perflutren-based ultrasound contrast agent yielded a 28% lower mortality rate at 48 hours in critically ill patients compared with non-contrast echocardiography.

The safety of perflutren-based ultrasound contrast agents has been previously questioned by the FDA in this patient population, as there have been reports of deaths or serious adverse reactions that may be related to use of these agents, according to background information in the study.

Researchers conducted the retrospective, observational outcome study using database information on critically ill patients aged 18 years or older who were discharged from hospitals between January 2002 and June 2008. All causes chosen for evaluation received transthoracic echocardiography (TTE), with or without a perflutren-based ultrasound contrast agent.

The researchers utilized a propensity score-matching algorithm between patients who underwent echocardiography with perflutren-based ultrasound contrast agents and patients who underwent non-contrast echocardiography. The algorithm was designed to minimize the possibility of imbalance in covariates of selected patients in comparing mortality between groups. Within the parameters of 48-hour all-cause mortality were cases with a discharge code of expired on the same day or in the 24-hour period after echocardiography. Hospital stay mortality categorization was ascribed to cases with a discharge code of expired on the same day, or the day after echocardiography, where the time between the echocardiography and the discharge code was less than 2 service days. A total of 990,159 patients were included in the non-contrast echocardiography group and 16,222 in the contrast group.

According to results, patients who had perflutren-based ultrasound contrast agent-enhanced echocardiography had a lower mortality at 48 hours compared with patients who had non-contrast echocardiography (1.7% vs. 2.5%; OR=0.66; 95% CI, 0.54-0.8). Hospital-stay mortality was also lower with contrast-enhanced echocardiography (14.85% vs. 15.66%; OR=0.89; 95% CI, 0.84-0.96).

 “These results are reassuring, given previous reports suggesting an association between ultrasound contrast agents and increased mortality in critically ill patients,” the researchers wrote.

Disclosure: See the study for a full list of the researchers’ relevant financial disclosures.

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