Abdelmoneim Sahar S, Bernier Mathieu, Scott Christopher G, Dhoble Abhijeet, Ness Sue Ann C, Hagen Mary E, Moir Stuart, McCully Robert B, Pellikka Patricia A, Mulvagh Sharon L
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
JACC Cardiovasc Imaging. 2009 Sep;2(9):1048-56. doi: 10.1016/j.jcmg.2009.03.020.
We evaluated the short- and long-term safety of contrast agents during stress echocardiography (SE).
Concerns about contrast agent safety led to revised recommendations for product use in the U.S.
We studied 26,774 patients who underwent SE between November 1, 2003, and December 31, 2007. The 10,792 patients who comprised the contrast cohort received second-generation perfluorocarbon-based agents for left ventricular opacification during SE. The noncontrast cohort comprised 15,982 patients who had their first SE in the same period but without contrast agents. Short-term (< or = 72 h and < or = 30 days) and long-term (up to 4.5 years) end points were death and myocardial infarction (MI). Cox regression models were used. Immediate contrast agent-related adverse effects were also reported.
The contrast cohort had older patients (mean [SD] age, 65.8 [12.1] years vs. 62.6 [14.1] years; p < 0.001), a higher percentage of males (57.4% vs. 52.8%, p < 0.001), and higher-risk patients compared with the noncontrast cohort. In addition, dobutamine SE patients had greater cardiac risk than exercise SE patients. Abnormal SE findings in patients who received contrast agents were more frequent (32.4% vs. 27.9%, p < 0.001). The 2 cohorts had no statistical difference in the incidence of short-term events (death and MI). Within 72 h, 1 patient in the contrast cohort and 2 patients in the noncontrast cohort died (p = 0.54); 3 in the contrast cohort and 7 in the noncontrast cohort had MI (p = 0.92). Within 30 days, 37 patients (0.34%) in the contrast cohort and 57 patients (0.36%) in the noncontrast cohort died (p = 0.85); 17 patients (0.16%) in the contrast cohort and 16 patients (0.10%) in the noncontrast cohort had MI (p = 0.19). Adjusted hazard ratios were not different between cohorts for death (0.99; 95% confidence interval: 0.88 to 1.11) or MI (0.99; 95% confidence interval: 0.80 to 1.22).
The use of contrast agents during SE was not associated with an increased short-term or long-term risk of death or MI.
我们评估了负荷超声心动图（SE）期间使用造影剂的短期和长期安全性。
对造影剂安全性的担忧导致美国对产品使用建议进行了修订。
我们研究了2003年11月1日至2007年12月31日期间接受SE检查的26774例患者。造影剂组的10792例患者在SE期间接受了第二代基于全氟碳的造影剂以实现左心室显影。非造影剂组包括同期进行首次SE检查但未使用造影剂的15982例患者。短期（≤72小时和≤30天）和长期（最长4.5年）终点为死亡和心肌梗死（MI）。使用Cox回归模型。还报告了与造影剂相关的即刻不良反应。
与非造影剂组相比，造影剂组患者年龄更大（平均[标准差]年龄，65.8[12.1]岁对62.6[14.1]岁；p<0.001），男性比例更高（57.4%对52.8%，p<0.001），且为高危患者。此外，多巴酚丁胺负荷超声心动图检查的患者比运动负荷超声心动图检查的患者心脏风险更高。接受造影剂的患者中异常SE表现更常见（32.4%对27.9%，p<0.001）。两组在短期事件（死亡和MI）发生率方面无统计学差异。在72小时内，造影剂组有1例患者死亡，非造影剂组有2例患者死亡（p=0.54）；造影剂组有3例发生MI，非造影剂组有7例发生MI（p=0.92）。在30天内，造影剂组有37例患者（0.34%）死亡，非造影剂组有57例患者（0.36%）死亡（p=0.85）；造影剂组有17例患者（0.16%）发生MI，非造影剂组有16例患者（0.10%）发生MI（p=0.19）。两组间死亡的校正风险比无差异（0.99；95%置信区间：0.88至1.11）或MI的校正风险比无差异（0.99；95%置信区间：0.80至1.22）。
SE期间使用造影剂与短期或长期死亡或MI风险增加无关。
