Incidence of Severe Adverse Drug Reactions to Ultrasound Enhancement Agents in a Contemporary Echocardiography Practice.

OBJECTIVES: Prior data indicate a very rare risk of serious adverse drug reaction (ADR) to ultrasound enhancement agents (UEAs). We sought to evaluate the frequency of ADR to UEA administration in contemporary practice. METHODS: We retrospectively reviewed 4 US health systems to characterize the frequency and severity of ADR to UEA. Adverse drug reactions were considered severe when cardiopulmonary involvement was present and critical when there was loss of consciousness, loss of pulse, or ST-segment elevation. Rates of isolated back pain and headache were derived from the Mayo Clinic Rochester stress echocardiography database where systematic prospective reporting of ADR was performed. RESULTS: Among 26,539 Definity and 11,579 Lumason administrations in the Mayo Clinic Rochester stress echocardiography database, isolated back pain or headache was more frequent with Definity (0.49% vs 0.04%, P < .0001) but less common with Definity infusion versus bolus (0.08% vs 0.53%, P = .007). Among all sites there were 201,834 Definity and 84,943 Lumason administrations. Severe and critical ADR were more frequent with Lumason than with Definity (0.0848% vs 0.0114% and 0.0330% vs 0.0010%, respectively; P < .001 for each). Among the 3 health systems with >2,000 Lumason administrations, the frequency of severe ADR with Lumason ranged from 0.0755% to 0.1093% and the frequency of critical ADR ranged from 0.0293% to 0.0525%. Severe ADR rates with Definity were stable over time but increased in more recent years with Lumason (P = .02). Patients with an ADR to Lumason since the beginning of 2021 were more likely to have received a COVID-19 vaccination compared with matched controls (88% vs 75%; P = .05) and more likely to have received Moderna than Pfizer-Biotech (71% vs 26%, P < .001). CONCLUSION: Severe and critical ADR, while rare, were more frequent with Lumason, and the frequency has increased in more recent years. Additional work is needed to better understand factors, including associations with recently developed mRNA vaccines, which may be contributing to the increased rates of ADR to UEA since 2021.

Anomalous coronary arteries in adults: depiction at multi-detector row CT angiography.

PURPOSE: To retrospectively determine the imaging features of anomalous coronary arteries depicted at multi-detector row computed tomographic (CT) angiography in 18 patients seen at four institutions. MATERIALS AND METHODS: Eighteen patients underwent imaging with a four- or 16-section multi-detector row CT unit by using retrospective electrocardiographic (ECG) gating after infusion of 120-150 mL of intravenous contrast material. Section thicknesses of 0.8-3.0 mm were achieved during breath holding, and images were reconstructed with a 50% overlap. Volumetric reconstructions were obtained for each patient. Each study was assessed retrospectively for the origin and course of the anomalous coronary artery by two thoracic radiologists; decisions were made in consensus. Institutional review board exemption and informed consent waiver was granted at each institution. The study was compliant with the Health Insurance Portability and Accountability Act. RESULTS: Seventeen patients were referred because of equivocal findings at cardiac catheterization or echocardiography; in one, the anomalous coronary artery was incidental. A total of 20 anomalous vessels were found. Twelve patients with 14 variant vessels had an anomalous origin of a left coronary artery (right cusp, 13; noncoronary cusp, one). In four patients, an anomalous right coronary artery originated from the left side; one patient had a single coronary artery arising from the right cusp. In one patient, a left coronary artery-to-vein fistula was observed. In 10 patients, the anomalous vessel passed between the aorta and the main pulmonary artery or right ventricular outflow track. In each case, the origin of the anomalous coronary artery and its course in relationship to the great vessels were unequivocally demonstrated. Volumetric images were useful for showing the three-dimensional orientation of the anomalous coronary artery with respect to the great vessels and cardiac chambers. CONCLUSION: Multi-detector row CT angiography provided accurate depiction of vessel origin and course in this review of 20 anomalous coronary arteries. The results of this study suggest that CT is a viable noninvasive modality for delineating coronary arterial anomalies, particularly if findings at coronary angiography are equivocal.