Illuminating the Safety of Ultrasound Contrast Agents

Abstract

Echocardiography is an essential element for accurate and timely diagnosis of cardiac pathology. In this context, ultrasound enhancing agents (UEAs), are often essential for visualizing endocardial borders,1 evaluating myocardial perfusion, characterizing intracardiac masses, and other applications. Although UEAs have been shown to be safe, rare serious adverse events (SAEs) have been reported. It is in this context that De La Fuente Gonzalez et al performed a systematic review evaluating randomized and observational data comparing the safety of UEA brands from 2018-2023. The authors conclude that “Optison reduces risk of serious adverse events vs. Definity/Lumason.” However, the data presented do not support such a conclusion, as will be discussed in this editorial. What can be concluded is that UEAs as a class are extremely safe with very rare SAEs. The use of UEAs during echocardiography are encouraged per guideline-directed indications based upon evidence-based reduction of misdiagnosis and duplicative testing.