Lower Short-Term Mortality Risk Found with Contrast-Enhanced Echocardiography
March 30, 2009 – Lantheus Medical Imaging Inc. released at ACC 2009 new data regarding the use of DEFINITY Vial For (Perflutren Lipid Microsphere) Injectable Suspension that finds significant survival benefit for critically ill patients undergoing contrast-enhanced echocardiography.
A large, retrospective study (abstract number 1027-265) presented by Michael Main, M.D., at ACC 2009 demonstrated that use of contrast-enhanced echocardiography was associated with a significantly improved short-term survival among critically ill, intensive care unit (ICU) patients, when compared with matched patients receiving non-contrast echocardiography. Patients who received contrast exhibited a 26 percent lower risk of short-term mortality within 48 hours after the exam when compared with patients who received echocardiography without the ultrasound contrast agent. Transthoracic echocardiography, the most common type of echocardiogram, uses a transducer on a person’s chest to send high frequency ultrasound waves through the chest wall to the heart to create pictures of the heart that physicians can then analyze.[i] DEFINITYis used to improve the images of suboptimal non-contrast echocardiograms.
These findings build on a recent multicenter retrospective study of over 4 million hospitalized patients published in the American Journal of Cardiology that also demonstrated that echocardiography with DEFINITY was associated with a lower risk of short-term mortality in comparison with patients undergoing non-DEFINITY echocardiograms (Main et al, American Journal of Cardiology, Volume 102, Issue 12, 2008).
“The data demonstrate a significantly lower risk of short-term mortality among critically ill patients receiving contrast-enhanced echocardiograms and affirm the clinical value of echocardiogram contrast agents as an important diagnostic tool for specialized patient populations,” said Michael L. Main, M.D., associate professor of medicine, University of Missouri, Kansas City, director, Echocardiography Laboratory, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, and lead author on the study. “Given the limited diagnostic options for critically ill patients, we are encouraged by these results that demonstrate the survival benefit of contrast-enhanced echocardiograms in an ICU setting.”
Using the Premier Perspective database, 145,882 adult inpatient records were matched by propensity score for age, race, gender, hospital and admission type, multiple co-morbid conditions and APR-DRG severity of illness. Of these, 39,189 patients were critically ill and in the ICU when the echocardiogram was performed, 19,318 patients received contrast-enhanced studies, approximately 78 percent of the total population received DEFINITY. A subset of 12,572 patients on mechanical ventilation was also examined.
Short-term mortality rates (<48 hours of echocardiogram) were 2.98 percent for patients undergoing non-contrast studies and 2.30 percent for patients undergoing contrast-enhanced examinations. A multivariate logistic regression analysis was used to compare short-term mortality, controlling for case mix and clinical covariates. Critically ill patients undergoing contrast-enhanced echocardiograms had a statistically significant 26 percent lower risk-adjusted odds ratio for 48-hour mortality than those patients who received only echocardiography without the ultrasound contrast agent. For those patients on mechanical ventilation, 48-hour mortality rates were 6.11 percent for those undergoing non-contrast exams and 4.59 percent for individuals with contrast-enhanced examinations, representing a 27 percent lower mortality rate for the contrast-enhanced group.
“With DEFINITY already widely used in the intensive care unit settings, the results confirm that there is a survival advantage associated with using echocardiogram contrast agents appropriately,” said Mark Hibberd, M.D., Ph.D., senior medical director, Global Medical Affairs, Lantheus Medical Imaging, Inc. and co-author on the study. “The contrast-associated survival advantage is important, especially in the mechanically ventilated patients, in whom routine echocardiography without contrast is especially challenging. The current database analysis does not allow us to draw conclusions on the reasons why contrast utilization is associated with a survival advantage. Some possible explanations include more accurate, faster diagnoses leading to better patient management decisions, and/or the avoidance of other potentially higher-risk or invasive tests that become unnecessary after contrast echocardiography.
"This study follows the recent publication of a prospective study by Kurt et al (Journal of the American College of Cardiology, Volume 53, Issue 9, March 3, 2009) in which it was demonstrated that echocardiogram image quality was significantly improved in 88 percent of those studies having suboptimal images without contrast and where the use of DEFINITY significantly changed patient management particularly in ICU/SICU patients. The Kurt et al study gives the medical community further clinical evidence of the important role DEFINITY can play in improving the standard of care for patients in the ICU.”
For more information: www.lantheus.com