Safety and Efficacy of Cardiac Ultrasound Contrast in Children and Adolescents for Resting and Stress Echocardiography

Shelby Kutty; Yunbin Xiao; Joan Olson; Feng Xie; David A Danford; Christopher C Erickson; Thomas R Porter

doi:10.1016/j.echo.2016.02.019

Safety and Efficacy of Cardiac Ultrasound Contrast in Children and Adolescents for Resting and Stress Echocardiography

J Am Soc Echocardiogr. 2016 Jul;29(7):655-62. doi: 10.1016/j.echo.2016.02.019. Epub 2016 Apr 1.

Authors

Shelby Kutty¹, Yunbin Xiao², Joan Olson³, Feng Xie³, David A Danford², Christopher C Erickson², Thomas R Porter³

Affiliations

¹ Division of Pediatric Cardiology, University of Nebraska College of Medicine, Children's Hospital & Medical Center, Omaha, Nebraska. Electronic address: skutty@unmc.edu.
² Division of Pediatric Cardiology, University of Nebraska College of Medicine, Children's Hospital & Medical Center, Omaha, Nebraska.
³ Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska.

PMID: 27049664
DOI: 10.1016/j.echo.2016.02.019

Abstract

Background: Small pilot studies of ultrasound contrast (UC) echocardiography in children have suggested that it is safe; therefore, larger scale evaluation of safety and efficacy in this population is of particular interest.

Methods: This was a retrospective study (January 2005 to June 2014). Known intracardiac shunt was the only exclusion criterion. UC echocardiography was performed on commercially available ultrasound systems using Definity (3% infusion). When indicated, real-time myocardial contrast echocardiography was performed at rest and stress, with examination of myocardial contrast replenishment, plateau intensity, and wall motion. The primary outcome was short-term safety and efficacy (<24 hours).

Results: In all, 113 patients (55% male; mean age, 17.8 ± 3 years; age range, 5-21 years) underwent UC echocardiography for left ventricular opacification or stress wall motion and perfusion analysis. Diagnosis categories were congenital heart disease (30%), acquired heart disease (21%), and other (suspected cardiac complications of disease of other organ systems; 49%). Twelve patients (11%) with right ventricular systolic pressures > 40 mm Hg received UC without complications; four of these (33%) had the highest right ventricular-right atrial gradient recorded with ultrasound contrast-enhanced Doppler. Myocardial perfusion and/or UC echocardiography-detected wall motion abnormalities were seen in 13 patients (12%); four had confirmed correlations by angiography or magnetic resonance imaging. There were 13 instances of adverse events or reported symptoms during UC echocardiography. All symptoms and events were transient, all patients completed protocols, and there were no immediate sequelae.

Conclusions: These data demonstrate the usefulness and safety of UC echocardiography in children and adolescents for a wide variety of indications. UC echocardiography provided myocardial perfusion and wall motion information important in clinical decision making.

Keywords: Adult congenital heart disease; Echocardiography; Pediatric; Stress echocardiography; Ultrasound contrast.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Arrhythmias, Cardiac / diagnosis
Arrhythmias, Cardiac / epidemiology*
Causality
Chest Pain / diagnosis
Chest Pain / epidemiology*
Child
Child, Preschool
Comorbidity
Dizziness / diagnosis
Dizziness / epidemiology
Dyspnea / diagnosis
Dyspnea / epidemiology
Echocardiography, Stress / methods*
Fatigue / diagnosis
Fatigue / epidemiology*
Female
Heart Diseases / diagnostic imaging*
Heart Diseases / epidemiology*
Humans
Male
Nebraska / epidemiology
Pain / diagnosis
Pain / epidemiology*
Patient Safety / statistics & numerical data
Prevalence
Reproducibility of Results
Retrospective Studies
Risk Factors
Sensitivity and Specificity
Young Adult