Does contrast echocardiography induce increases in markers of myocardial necrosis, inflammation and oxidative stress suggesting myocardial injury?

20 patients who underwent contrast echocardiography with Optison as the contrast medium were investigated. To evaluate myocardial micro-necrosis, inflammation and oxidative stress, cardiac troponin I (cTnI), tumor necrosis factor-α (TNF-α), interleukin (IL)-6, -8 and thiobarbituric acid reactive substances (TBARS) were measured at baseline and at 2, 4, 8 and 24 hours after contrast echocardiography.At baseline, 50% of the patients had cTnI and TBARS values outside the reference range. TNF-α, IL-6, IL-8 levels were within the reference range. Patients with cTnI above the RR clustered to significantly higher levels of TNF-α and IL-6. After contrast echocardiography, no statistically significant increase of cTnI, cytokines and TBARS was found. However, for nearly 50% of the patients, the intra-individual cTnI kinetics crossed the critical difference (threefold of methodical variation) which indicates a marker increase. This was neither predicted by the baseline levels of the cytokines nor the markers of oxidative stress.There are no clinically relevant increases in serum markers for micro-necrosis, inflammation and oxidative stress in humans after contrast echocardiography. Future studies have to address whether cTnI increase in some patients represent a subset with increased risk for side effects after contrast echocardiography.Contrast echocardiography is a precise and study-proven tool for the non-invasive assessment of left ventricular systolic function, myocardial perfusion, endocardial border detection and coronary flow reserve [1,2].Myocardial trauma, e.g. occlusion of a coronary artery during angioplasty, can potentially stimulate inflammatory processes with subsequent activation and infiltration of inflammatory cells in the myocardium. This can induce the release of cytokines and reactive oxygen species [3]. Microbubbles in their use as ultrasound contrast agents, which are destroyed by ultrasound, potentially also pose a risk for myocardial micro-lesions. Thi