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Filippone A, Kirchin MA, Monteith J, Storto ML, Spinazzi A. Safety of Lumason® (SonoVue®) in special populations and critically ill patients. Front Cardiovasc Med 2023; 10:1225654. [PMID: 37600063 PMCID: PMC10433219 DOI: 10.3389/fcvm.2023.1225654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Evidence for the safe use of Lumason® (SonoVue®), an ultrasound enhancing agent (UEA), in special patient populations is critical to enable healthcare professionals to make informed decisions concerning its use in such patients. Herein, we provide insight on the safety and tolerability of Lumason® in special patient populations. Findings are presented from clinical pharmacology studies conducted in patients with compromised cardiopulmonary conditions, from a retrospective study performed in critically ill patients, and from post-marketing surveillance data from over 20 years of market use of Lumason® (SonoVue®). No detrimental effects of Lumason® on cardiac electrophysiology were observed in patients with coronary artery disease (CAD), and no significant effects on pulmonary hemodynamics were noted in patients with pulmonary hypertension or congestive heart failure. Similarly, no effects on several assessments of pulmonary function (e.g., FVC) were observed in patients with chronic obstructive pulmonary disease (COPD), and no clinically meaningful changes in O2 saturation or other safety parameters were observed after administration of Lumason® to patients with diffuse interstitial pulmonary fibrosis (DIPF). The retrospective study of critically ill patients revealed no significant difference for in-hospital mortality between patients administered Lumason® for echocardiography versus those who had undergone echocardiography without contrast agent. Post-marketing surveillance revealed very low reporting rates (RR) for non-serious and serious adverse events and that serious hypersensitivity reactions were rare. These findings confirm that Lumason® is a safe and well tolerated UEA for use in special populations and critically ill patients.
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Affiliation(s)
- A. Filippone
- Global Medical & Regulatory Affairs, Bracco Imaging SpA, Milan, Italy
| | - M. A. Kirchin
- Global Medical & Regulatory Affairs, Bracco Imaging SpA, Milan, Italy
| | - J. Monteith
- Global Medical & Regulatory Affairs, Bracco Diagnostics Inc., Monroe, NJ, United States
| | - M. L. Storto
- Global Medical & Regulatory Affairs, Bracco Diagnostics Inc., Monroe, NJ, United States
| | - A. Spinazzi
- Global Medical & Regulatory Affairs, Bracco Diagnostics Inc., Monroe, NJ, United States
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Salih M, Ali SM, Jena N, Ananthasubramaniam K. Review of ultrasound contrast agents in current clinical practice with special focus on DEFINITY ® in cardiac imaging. Future Cardiol 2020; 17:197-214. [PMID: 32897099 DOI: 10.2217/fca-2020-0049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Echocardiography is the most widely used noninvasive modality to evaluate the structure and function of the cardiac muscle in daily practice. However, up to 15-20% of echocardiograms are considered suboptimal. To enable accurate assessment of cardiac function and wall motion abnormality, the use of ultrasound microbubble contrast has shown substantial benefits in cases of salvaging nondiagnostic studies and enhancing the diagnostic accuracy in daily practice. DEFINITY® is a perflutren based, lipid shelled microbubble contrast agent, which is US FDA approved for left ventricular opacification. The basis of ultrasound microbubbles, its development, and the clinical role of DEFINITY (characteristics, indications and case examples, side effect profile and existing evidence) is the subject of discussion in this review.
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Affiliation(s)
- Mohammed Salih
- Department of Medicine, St Joseph Mercy Oakland Hospital, Pontiac, MI 48341, USA
| | - Syed Musadiq Ali
- Department Of Cardiology, Beth Israel Deaconess Hospital, Boston, MA 02215, USA
| | - Nihar Jena
- Department of Medicine, St Joseph Mercy Oakland Hospital, Pontiac, MI 48341, USA
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Abstract
PURPOSE OF REVIEW Non-invasive molecular imaging is currently used as a research technique to better understand disease pathophysiology. There are also many potential clinical applications where molecular imaging may provide unique information that allows either earlier or more definitive diagnosis, or can guide precision medicine-based decisions on therapy. Contrast-enhanced ultrasound (CEU) with targeted microbubble contrast agents is one such technique that has been developed that has the unique properties of providing rapid information and revealing information only on events that occur within the vascular space. RECENT FINDINGS CEU molecular probes have been developed for a wide variety of disease states including atherosclerosis, vascular inflammation, thrombosis, tumor neovascularization, and ischemic injury. While the technique has not yet been adapted to clinical use, it has been used to reveal pathological processes, to identify new therapeutic targets, and to test the efficacy of novel treatments. This review will explore the physical basis for CEU molecular imaging, its strengths and limitations compared to other molecular imaging modalities, and the pre-clinical translational research experience.
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Affiliation(s)
- Eran Brown
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.,Knight Cardiovascular Institute, UHN-62, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, USA
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, UHN-62, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, USA. .,Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland, OR, USA.
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Contrast-enhanced ultrasound of the liver: technical and lexicon recommendations from the ACR CEUS LI-RADS working group. Abdom Radiol (NY) 2018; 43:861-879. [PMID: 29151131 DOI: 10.1007/s00261-017-1392-0] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) is a specific form of ultrasound imaging performed with intravenous administration of microbubble contrast agents. It has been extensively used for liver tumor characterization and was recently added to the American College of Radiology Liver Imaging Reporting and Data System (CEUS LI-RADS). This paper describes technical recommendations for successful liver CEUS lesion characterization, and provides imaging protocol and Lexicon of imaging findings.
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Porter TR, Mulvagh SL, Abdelmoneim SS, Becher H, Belcik JT, Bierig M, Choy J, Gaibazzi N, Gillam LD, Janardhanan R, Kutty S, Leong-Poi H, Lindner JR, Main ML, Mathias W, Park MM, Senior R, Villanueva F. Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography: 2018 American Society of Echocardiography Guidelines Update. J Am Soc Echocardiogr 2018; 31:241-274. [DOI: 10.1016/j.echo.2017.11.013] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
In October 2007, the Food and Drug Administration mandated significant revisions to product labeling for the commercially available echocardiographic contrast agents (ECA) Definity and Optison after spontaneous healthcare provider reports of 4 patient deaths and ≈190 severe cardiopulmonary reactions occurring in close temporal relationship to ECA administration. Since then, multiple large ECA safety studies have been published and have included outpatients, hospitalized patients (including the critically ill), patients undergoing stress echocardiography, and patients with pulmonary hypertension. In addition, the Food and Drug Administration has convened 2 Advisory Committee meetings and the product labels for Optison and Definity have been substantially revised with a softening of safety restrictions. In this review, we will address the safety of ECA use in patients with serious cardiopulmonary conditions, patients with intracardiac shunts, and special patient populations including pulmonary hypertension, pediatrics, and pregnancy. In addition, we will discuss the confounding role of pseudocomplication in attribution of adverse events during diagnostic testing, the current status of the ECA Black Box Warning, and recommended safety precautions during ECA administration.
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Affiliation(s)
| | - Michael L. Main
- From Saint Luke’s Mid America Heart Institute, Kansas City, MO
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Karogiannis N, Senior R. Contrast echocardiography for detection of myocardial perfusion abnormalities. Herz 2017; 42:287-294. [DOI: 10.1007/s00059-017-4536-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Opacic T, Paefgen V, Lammers T, Kiessling F. Status and trends in the development of clinical diagnostic agents. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2016; 9. [DOI: 10.1002/wnan.1441] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/02/2016] [Accepted: 09/15/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Tatjana Opacic
- Department of Experimental Molecular Imaging; RWTH Aachen University; Aachen Germany
| | - Vera Paefgen
- Department of Experimental Molecular Imaging; RWTH Aachen University; Aachen Germany
| | - Twan Lammers
- Department of Experimental Molecular Imaging; RWTH Aachen University; Aachen Germany
- Department of Pharmaceutics; Utrecht University; Utrecht The Netherlands
- Department of Targeted Therapeutics; University of Twente; Enschede The Netherlands
| | - Fabian Kiessling
- Department of Experimental Molecular Imaging; RWTH Aachen University; Aachen Germany
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Appis AW, Tracy MJ, Feinstein SB. Update on the safety and efficacy of commercial ultrasound contrast agents in cardiac applications. Echo Res Pract 2015; 2:R55-62. [PMID: 26693339 PMCID: PMC4676450 DOI: 10.1530/erp-15-0018] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/22/2015] [Indexed: 12/27/2022] Open
Abstract
Ultrasound contrast agents (UCAs) are currently used throughout the world in both clinical and research settings. The concept of contrast-enhanced ultrasound imaging originated in the late 1960s, and the first commercially available agents were initially developed in the 1980s. Today's microbubbles are designed for greater utility and are used for both approved and off-label indications. In October 2007, the US Food and Drug Administration (FDA) imposed additional product label warnings that included serious cardiopulmonary reactions, several new disease-state contraindications, and a mandated 30 min post-procedure monitoring period for the agents Optison and Definity. These additional warnings were prompted by reports of cardiopulmonary reactions that were temporally related but were not clearly attributable to these UCAs. Subsequent published reports over the following months established not only the safety but also the improved efficacy of clinical ultrasound applications with UCAs. The FDA consequently updated the product labeling in June 2008 and reduced contraindications, although it continued to monitor select patients. In addition, a post-marketing program was proposed to the sponsors for a series of safety studies to further assess the risk of UCAs. Then in October 2011, the FDA leadership further downgraded the warnings after hearing the results of the post-marketing data, which revealed continued safety and improved efficacy. The present review focuses on the use of UCAs in today's clinical practice, including the approved indications, a variety of off-label uses, and the most recent data, which affirms the safety and efficacy of UCAs.
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Affiliation(s)
- Andrew W Appis
- Division of Cardiology, Rush University Medical Center , 1653 West Congress Parkway, Chicago, Illinois, 60612 , USA
| | - Melissa J Tracy
- Division of Cardiology, Rush University Medical Center , 1653 West Congress Parkway, Chicago, Illinois, 60612 , USA
| | - Steven B Feinstein
- Division of Cardiology, Rush University Medical Center , 1653 West Congress Parkway, Chicago, Illinois, 60612 , USA
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Becher H, Gibson PH. Contrast Echocardiography: Current Applications and Future Perspectives. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9234-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Main ML. Contrast Echocardiography: Safety in Numbers. Cardiology 2012; 122:248-50. [DOI: 10.1159/000341246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 06/19/2012] [Indexed: 11/19/2022]
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