09/17/2025
While recently published research suggested an increase in severe allergic reactions associated with ultrasound-enhancing agents (UAEs), a new nationwide study involving over 11 million patients found that UAE use for transthoracic (TTE) or stress echocardiography (SE) was linked to lower rates of death.
For the retrospective study, recently published in the Journal of the American Heart Association, researchers reviewed data from a nationwide claims database for 11,421,463 individuals (mean age of 57.5) who had TTE or SE. According to the study, UEAs were utilized for 500,073 patients (4.4 percent of the total cohort).
The study authors found that the overall all-cause death rate was lower with UEA use in comparison to no UEA use in the cohort (0.02 percent vs. 0.14 percent). After propensity matching, the all-cause death rate declined to 0.07 percent for patients who did have UEAs for TTE or SE exams.
The researchers also noted comparable rates of adverse events between UEA use and no UEA use for patients undergoing TTE or SE. In addition to an equivalent rate of anaphylaxis (0.01 percent), the study authors pointed out no statistically significant differences in the between the groups in the propensity-matched cohort with respect to rates of myocardial infraction (1.97 percent for UEA use vs. 1.67 percent for no UEA use), ventricular tachycardia (0.99 percent vs. 0.8 percent) and cardiac arrest (0.12 percent vs. 0.26 percent).
“These results overall underscore the continued safety of UEAs in nationwide practice and suggest observed differences across agents may be due in part to the settings in which these agents are used and patient comorbidities,” wrote lead author Jordan B. Strom, M.D., MSc, who is affiliated with the Department of Medicine and the Cardiovascular Division at the Beth Israel Deaconess Medical Center in Boston, and colleagues.
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