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European Heart Journal Advance Access originally published online on April 4, 2007
European Heart Journal 2007 28(10):1236-1241; doi:10.1093/eurheartj/ehm051
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Release of cardiac bio-markers during high mechanical index contrast-enhanced echocardiography in humans

David Vancraeynest1, Joelle Kefer1, Claude Hanet1, Catherine Fillee2, Christophe Beauloye1, Agnes Pasquet1, Bernhard L. Gerber1, Marianne Philippe2 and Jean-Louis J. Vanoverschelde1,*

1 From the division of Cardiology, Université Catholique de Louvain, School of Medicine, Brussels, Belgium
2 From the clinical Biology Laboratory, Université Catholique de Louvain, School of Medicine, Brussels, Belgium

Received 8 September 2006; revised 19 February 2007; accepted 1 March 2007; online publish-ahead-of-print 4 April 2007.

* Corresponding author. Tel: +32 2 764 28 03; fax: +32 2 764 89 80. E-mail address: vanoverschelde{at}card.ucl.ac.be

See page 1190 for the editorial comment on this article (doi:10.1093/eurheartj/ehm110)

Background: Recent experimental data have shown that the combined exposure of rodent hearts to high acoustic pressure and ultrasound contrast agents can induce vascular injury and cell damage. The aim of the present work was to test whether similar effects can be observed in humans.

Methods and results: Twenty patients underwent simultaneous arterial and coronary sinus blood sampling during contrast-enhanced echocardiography using Perfluorocarbon-enhanced Sonicated Dextrose Albumin. Control subjects were compared to groups of patients exposed to either high mechanical index (MI = 1.5) triggered second harmonic (1.3–2.6 MHz) imaging or low mechanical index (MI = 0.2) real-time power modulation imaging for 15 min. No significant changes arterio-venous differences in lactate, total creatine kinase (CK) and myoglobin occurred over time in the three groups. Similarly, the arterio-venous difference in CK-MB and troponin I remained stable over time in control and low-MI patients. By contrast, these two parameters progressively increased over time in the high-MI group (P < 0.05 vs. baseline and vs. controls).

Conclusion: Our data suggest that high-MI contrast-enhanced echocardiography can cause subclinical release of cardiac bio-markers in humans, while low-MI real-time imaging appears to be safer.

Key Words: Contrast echocardiography • Cardiac markers • Safety • Myocardial damage


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