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Wilson RF. Coronary Angiography. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Multicenter Comparison of High Concentration Contrast Agent Iomeprol-400 With Iso-osmolar Iodixanol-320. Invest Radiol 2011; 46:457-64. [DOI: 10.1097/rli.0b013e31821c7ff4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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3
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Kenigsberg DN, Khanal S, Kowalski M, Krishnan SC. Prolongation of the QTc interval is seen uniformly during early transmural ischemia. J Am Coll Cardiol 2007; 49:1299-305. [PMID: 17394962 DOI: 10.1016/j.jacc.2006.11.035] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Revised: 10/16/2006] [Accepted: 11/16/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES In order to more clearly understand the electrocardiographic manifestations of early transmural ischemia, we studied electrocardiograms (ECGs) in patients undergoing balloon angioplasty. BACKGROUND Decisions regarding reperfusion strategies in patients with acute myocardial infarction rely largely on the presence of ST-segment elevation (STE) in the ECG, consequently with significant limitations. Studies of the "ischemic cascade" show that ST-segment changes occur well after the onset of wall motion abnormalities. METHODS We prospectively analyzed ECGs obtained at 20-s intervals in 74 patients undergoing elective balloon angioplasty. The ECGs were analyzed using 3 methodologies. In 74 patients, the ST-segment, the T-wave, and the QT-interval were analyzed using the MUSE (General Electric HC, Menomonee Falls, Wisconsin) automated system (MUSE). Fifty patients were also analyzed using the Interval Editor automated system (IE; General Electric HC). In 20 patients, measurements were made manually. RESULTS Transmural ischemia prolonged the QTc interval (using the Bazett's formula) in 100% of patients. In all 74 patients analyzed with MUSE, QTc interval prolonged from 423 +/- 25 ms to 455 +/- 34 ms (p < 0.001). In the 50 patients analyzed with IE, QTc interval prolonged in 50 of 50 (100%) patients (from 424 +/- 27 ms to 458 +/- 33 ms [p < 0.001]). Mean time to maximal QTc interval prolongation, changes in T-wave polarity, > or =1 mm STE, and ST-segment depression (STD) were 22, 24, 29, and 35 s, respectively. Although QTc interval prolonged in 100% of patients, T-wave changes, STE, and STD (> or =1 mm) occurred in 7%, 15%, and 7%, respectively. CONCLUSIONS The QTc interval prolongs in 100% of patients with early transmural ischemia. When compared with clinically accepted indexes of transmural ischemia (i.e., STD and STE [> or =1 mm]) it is the earliest ECG abnormality.
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Affiliation(s)
- David N Kenigsberg
- Henry Ford Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan, USA
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4
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Wilson RF, White CW. Coronary Angiography. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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5
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Emori T, Fujieda H, Ohe T. Polymorphic ventricular tachycardia induced by intracoronary injection of ioxaglate in a patient with borderline QT prolongation. J Cardiovasc Electrophysiol 1996; 7:962-6. [PMID: 8894938 DOI: 10.1111/j.1540-8167.1996.tb00470.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A 68-year-old female patient with borderline QT prolongation developed polymorphic ventricular tachycardia soon after intracoronary injection of ioxaglate. There was no coronary stenosis or vasospasm. To investigate abnormality of the ventricular repolarization, we recorded the monophasic action potential (MAP) during coronary angiography. Ioxaglate prolonged the MAP duration regionally in the perfused area and produced temporal dispersion of ventricular repolarization.
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Affiliation(s)
- T Emori
- Department of Cardiovascular Medicine, Okayama University Medical School, Japan
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6
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Jynge P. Sodium-calcium balance in coronary angiography and experimental experience with iodixanol. Eur Radiol 1996; 6 Suppl 2:S8-12. [PMID: 8798049 DOI: 10.1007/bf02342565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The present short review describes the physiological effects of rapid transient changes in cardiac extracellular ions (electrolytes) caused by the bolus of x-ray contrast medium (CM) during coronary angiography. The underlying hypothesis is that as the molecular and osmolal toxicities of modern CM is low, cardiac side-effects result mainly from secondary and biphasic ionic changes which occur during the initial washout phase and during the later reintroduction of blood. In particular, the washout pattern for sodium (Na) and calcium (Ca) has great influence on cardiac function. Thus the Na-Ca exchange system of the cardiac cell membrane plays a pivotal role in controlling intracellular Ca and contractility during very brief coronary bolus injections of both nonionic and ionic CM. The nonionic dimeriodixanol is hyposmolal without an additive. Animal experiments demonstrate the value of taking myocardial Na-Ca relationships into careful consideration when adding ions to iodixanol and formulating an isotonic CM like Visipaque.
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Affiliation(s)
- P Jynge
- Department of Physiology and Biomedical Engineering, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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7
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Fattori R, Piva R, Schicchi F, Pancrazi A, Gabrielli G, Marzocchi A, Piovaccari G, Blandini A, Magnani B. Iomeprol and iopamidol in cardiac angiography: a randomised, double-blind, parallel-group comparison. Eur J Radiol 1994; 18 Suppl 1:S61-6. [PMID: 8020520 DOI: 10.1016/0720-048x(94)90095-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
During cardiac angiography, hemodynamic alterations and surface electrocardiographic changes are common, predictable and dose-related adverse reactions to radiocontrast media. High osmolality, inadequate sodium content and local transient hypocalcemia are thought to be the main mechanisms responsible for these untoward cardiovascular effects. The purpose of this double-blind, parallel-group trial was to compare the hemodynamic and electrocardiographic responses to cardiac and selective coronary artery injection of iomeprol 400 (400 mgI/ml) and iopamidol 370 (370 mgI/ml). One-hundred consenting adult inpatients were randomised to receive iomeprol 400 (41 males, nine females; mean age, 56.6 years) or iopamidol 370 (46 males, four females; mean age, 57.6 years). Both agents produced minor and transient hemodynamic and electrophysiological effects. Following left ventriculography, iopamidol 370 produced a significantly greater increase in LVEDP than iomeprol 400 (mean increases after first and second left ventriculogram: 2.5 and 4.6 mmHg with iomeprol 400, 3.3 and 9.9 mmHg with iopamidol 370, P = 0.027). The QT-interval was more affected by iopamidol 370 than by iomeprol 400. However, post-contrast prolongation of the QT-interval was not significant with either agent, nor were there any significant T-wave, ST-segment or RR-interval changes associated with the injection of the test compounds. No serious adverse events occurred throughout the study. Mild pain was complained by only one patient, while most patients reported mild to moderate sensation of heat. Image quality of the vast majority of the procedures was rated as good or excellent in both patient groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R Fattori
- Cardiac Catheterization Laboratory, Ospedale Cardiologico Lancisi, Ancona, Italy
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Ritchie JL, Nissen SE, Douglas JS, Dreifus LS, Gibbons RJ, Higgins CB, Schelbert HR, Seward JB, Zaret BL. Use of nonionic or low osmolar contrast agents in cardiovascular procedures. American College of Cardiology Cardiovascular Imaging Committee. J Am Coll Cardiol 1993; 21:269-73. [PMID: 8417070 DOI: 10.1016/0735-1097(93)90747-o] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Low osmolar contrast agents produce less adverse electrophysiologic and hemodynamic alterations during cardiac catheterization. The nonionic agents probably reduce the risk of provoking myocardial ischemia during coronary arteriography or ventriculography. Patients also report less subjective sensation of discomfort during administration of low osmolar agents for cardiovascular procedures. However, nonionic agents have not been proved to reduce the incidence of several serious complications of cardiac catheterization, including acute renal failure and anaphylactoid reaction. Although evidence is inconclusive, there may be an increased risk of thromboembolic complications during cardiac catheterization when certain low osmolar nonionic agents are administered. Nonionic contrast agents have not been definitely proved to reduce the risk of death after cardiac catheterization.
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Gertz EW, Wisneski JA, Miller R, Knudtson M, Robb J, Dragatakis L, Browne KF, Vetrovec G, Smith SC. Adverse reactions of low osmolality contrast media during cardiac angiography: a prospective randomized multicenter study. J Am Coll Cardiol 1992; 19:899-906. [PMID: 1552109 DOI: 10.1016/0735-1097(92)90268-r] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A multicenter study was performed to determine the incidence of adverse reactions to two contrast media with similar low osmolality during cardiac angiography. The study was of a randomized double-blind design comparing ioxaglate (an ionic dimer) and iopamidol (a nonionic compound) and included 500 patients; 250 patients received ioxaglate and 250 iopamidol. There were 58 adverse reactions attributed to the contrast media in the ioxaglate group and 29 in the iopamidol group (p less than 0.001). Chest pain occurred in 11 patients in the ioxaglate group compared with 5 in the iopamidol group (p = 0.123). Nausea or vomiting was present in 20 and 2 patients, respectively (p less than 0.0003). Allergic adverse reactions, such as bronchospasm, urticaria and itching, occurred in 15 of the ioxaglate group and only 1 of the patients receiving iopamidol (p less than 0.0007). Fifty-two patients in the ioxaglate group had a known allergic history (not to contrast medium) or asthma, whereas 77 receiving iopamidol had a similar history. Seven of the 52 ioxaglate-treated patients developed an allergic adverse reaction compared with none of the 77 in the iopamidol group (p = 0.001). Of 41 patients receiving ioxaglate who were premedicated with diphenhydramine, 4 had an allergic adverse event. In the iopamidol group 45 patients received similar premedication and none had an allergic adverse reaction (p less than 0.03). Thus, this multicenter study shows that adverse reactions occur more often with ioxaglate than with iopamidol and that patients with an allergic history have a greater risk with ioxaglate therapy compared with iopamidol.
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Affiliation(s)
- E W Gertz
- Department of Medicine, University of California
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10
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Lembo NJ, King SB, Roubin GS, Black AJ, Douglas JS. Effects of nonionic versus ionic contrast media on complications of percutaneous transluminal coronary angioplasty. Am J Cardiol 1991; 67:1046-50. [PMID: 2024591 DOI: 10.1016/0002-9149(91)90863-g] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
To evaluate the effect of contrast agents on percutaneous transluminal coronary angioplasty (PTCA) complications, 913 patients undergoing 1,058 separate PTCA procedures were prospectively randomized to receive either nonionic iopamidol (Isovue-370) [n = 507 PTCA procedures] or ionic contrast media, meglumine sodium diatrizoate (Renografin-76) [n = 551 PTCA procedures]. Angioplasty operators, technicians, nurses and patients were blinded to the agent used. All patients were pretreated with 0.6 mg of atropine sulfate intravenously before any contrast injections. Hypotension (mean arterial pressure less than 65 mm Hg associated with contrast injections) occurred during 8.5% of PTCA procedures in which the patients were receiving iopamidol and during 9.5% of the procedures in which the patients were given diatrizoate (difference not significant). Bradycardia (heart rate of less than 40 beats/min associated with contrast injections) developed during 5.7% of procedures when patients were given iopamidol and during 5.1% of procedures when patients were given diatrizoate (difference not significant). The need for additional atropine or temporary pacing during the procedure was similar for patients given iopamidol and diatrizoate. The overall incidence of ventricular tachycardia or fibrillation, or both, during the procedure occurred less frequently when iopamidol was used compared with diatrizoate (1 vs 2.5%, p = 0.045). These serious ventricular arrhythmias were attributable to contrast injections in 0.6% of the PTCA procedures when iopamidol was given and in 2.0% of the cases in which diatrizoate was the contrast agent (p = 0.09). Only 1 patient had an allergic reaction to the contrast agent, and this was in a patient who received iopamidol.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- N J Lembo
- Department of Medicine (Division of Cardiology), Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Emory University Hospital, Atlanta, Georgia 30322
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Cooper MW, Reed PJ. Comparison of ionic and non-ionic contrast agents in cardiac catheterization: the effects of ventriculography and coronary arteriography on hemodynamics, electrocardiography, and serum creatinine. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1991; 22:267-77. [PMID: 1781822 DOI: 10.1002/ccd.1810220405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We compared two nonionic contrast agents (ioxaglate and iohexol) with an ionic agent (Renografin-76) on the effects of ventriculography and coronary arteriography on the hemodynamics, electrocardiography, and serum creatinine in one hundred consecutive patients. Patients were randomized to nonionic or ionic groups and were further evaluated regarding the effect of fluid loading prior to catheterization. The ionic agent more often produced subjective reactions (rash, nausea/vomiting). Following ventriculography, both ionic and non-ionic agents produced an increase in left ventricular end diastolic pressure and this effect was undetermined by fluid loading. Nonionic agents decreased aortic diastolic pressure following ventriculography and this effect was unaltered by fluid loading. In contrast, the ionic agent produced profound hemodynamic changes (drop in both systolic and diastolic pressures) following coronary arteriography and these effects were blunted by prior fluid loading. The ionic agent produced significantly greater heart rate slowing and prolongation of the QT interval than the nonionic agents, suggesting that the latter are potentially less arrhythmogenic. Comparing the two non-ionic agents, we found that both decreased aortic diastolic pressure and increased left ventricular end diastolic pressure following ventriculography. Iohexol produced greater heart rate slowing than did ioxaglate, though the increase was minor compared to the ionic agent. Neither nonionic agent appeared to significantly affect serum creatinine. In conclusion, the two nonionic agents appeared to offer significant advantages over the ionic agent in ventriculography and coronary arteriography.
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Affiliation(s)
- M W Cooper
- Texas Tech University Health Science Center, Lubbock
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12
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Matthai WH, Hirshfeld JW. Choice of contrast agents for cardiac angiography: review and recommendations based on clinically important distinctions. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1991; 22:278-89. [PMID: 2032273 DOI: 10.1002/ccd.1810220406] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Low osmolal contrast agents (LOCA) are measurably superior to high osmolal contrast agents (HOCA) in a number of properties. However, LOCA are substantially more expensive than HOCA, and universal use of LOCA for cardiac angiography would strain the health care budget. Therefore, the choice to use LOCA in place of HOCA should be based on clinically important differences. Review of available published data suggests that HOCA can be used safely and effectively for cardiac angiography in patients with mild or moderately severe heart disease. When HOCA are used, those that do not bind calcium should be chosen as they cause fewer clinically important adverse reactions than those that do bind calcium. Use of LOCA may offer added safety in high risk patients, although to date, this conclusion has not been proved with clinical experience. Nonionic LOCA may be safer to use than ionic LOCA.
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Affiliation(s)
- W H Matthai
- Cardiac Catheterization Laboratory, Hospital of the University of Pennsylvania, Philadelphia 19104
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Missri J, Jeresaty RM. Ventricular fibrillation during coronary angiography: reduced incidence with nonionic contrast media. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1990; 19:4-7. [PMID: 2306765 DOI: 10.1002/ccd.1810190103] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Ventricular fibrillation during coronary angiography with Renografin-76 has been attributed to the high osmolar ionic and calcium binding additive properties. Isovue-370 is a new low osmolar nonionic contrast medium lacking calcium binding additives. The present investigation compared the incidence of contrast media-induced ventricular fibrillation in patients undergoing coronary angiography with Renografin-76 to that with Isovue-370. Group I consisted of 2,000 consecutive patients undergoing coronary angiography with Renografin-76, and group II consisted of 2,000 subsequent consecutive patients in whom Isovue-370 was employed as the contrast medium. There was no significant difference between groups I and II with respect to volume of contrast media used per patient (125 +/- 35 vs. 140 +/- 45 ml), age (63.5 +/- 15 vs. 60 +/- 17 years), sex (74% male vs. 76% male), ejection fraction (55% vs. 55%), valvular heart disease (8% vs. 9%), prior coronary artery bypass graft surgery (5.8% vs. 5%), or extent of coronary artery disease. Contrast media-induced ventricular fibrillation occurred in 20 patients in group I (incidence 1%), whereas eight episodes occurred in group II (incidence 0.4%) (P less than 0.03). Thus the present investigation suggests that the incidence of ventricular fibrillation during coronary angiography can be significantly decreased by using low osmolar nonionic contrast media lacking calcium binding additives.
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Affiliation(s)
- J Missri
- Section of Cardiology, Saint Francis Hospital and Medical Center, Hartford, Connecticut
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14
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Pinto IM, Kou WH, McGillem MJ, DeBoe SF, Mickelson JK, Mancini GB. Induction of ventricular arrhythmia by high and low osmolarity ionic and nonionic contrast media. Am Heart J 1989; 117:1283-7. [PMID: 2471401 DOI: 10.1016/0002-8703(89)90407-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Studies that used prolonged contrast media infusion in canine arteries have generated controversy regarding the arrhythmogenic potential of low osmolarity, nonionic contrast agents. In order to establish the relative safety of these agents in the more typical setting of bolus injections, 4 ml intracoronary bolus injections of Hypaque-76 (n = 54), Iohexol-350 (n = 51), and Iohexol-140 (n = 51) were given in random order to 10 anesthetized, open-chest dogs undergoing programmed cardiac stimulation. Hemodynamics and electrocardiogram were monitored during stimulation, both during and for 2 minutes after the end of contrast infusion. Occurrence of evoked single and coupled premature ventricular contractions and nonsustained ventricular tachycardia did not differ statistically among agents. Sustained ventricular tachycardia (five episodes) and ventricular fibrillation (seven episodes) occurred only after Hypaque-76 injections (p less than 0.002). These results differ from those in studies that use continuous contrast infusion and suggest that low osmolarity nonionic contrast agents are as safe as high osmolarity nonionic contrast media. Both appear safer than ionic contrast material.
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Affiliation(s)
- I M Pinto
- Department of Internal Medicine, Veterans Administration Medical Center, Ann Arbor, MI 48105
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Wisneski JA, Gertz EW, Dahlgren M, Muslin A. Comparison of low osmolality ionic (ioxaglate) versus nonionic (iopamidol) contrast media in cardiac angiography. Am J Cardiol 1989; 63:489-95. [PMID: 2916435 DOI: 10.1016/0002-9149(89)90325-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A double-blind randomized study was performed in 60 patients to compare the electrocardiographic and hemodynamic changes induced during cardiac angiography by 2 contrast media with relatively low osmolality. Ioxaglate meglumine sodium, an ionic dimer contrast medium, was compared with iopamidol, a nonionic compound. Of the 30 patients who received ioxaglate, 13 (43%) experienced a mild to moderate adverse reaction to the contrast media, while only 2 of the 30 patients (7%) in the iopamidol group had similar side effects (p less than 0.005). Significant prolongations of the QT intervals occurred with the ioxaglate injections. The QT intervals increased from 402 +/- 46 to 442 +/- 59 ms (p less than 0.001) with the right coronary artery injection and similar changes were observed after the left coronary artery injection and left ventriculography. Significant ST-segment and T-wave amplitude changes also occurred in the ioxaglate group. With iopamidol injections, there were no significant changes in any of these parameters. After the left ventriculogram, there were similar decreases in the systolic arterial pressures in both groups (-14 +/- 10 mm Hg with ioxaglate and -21 +/- 9 mm Hg with iopamidol). The left ventricular end-diastolic pressures increased after the ventriculogram in both groups (5 +/- 5 vs 2 +/- 3 mm Hg with ioxaglate and iopamidol, respectively, 60 seconds after the injection). This report demonstrates that mild to moderate adverse reactions, QT-interval prolongations, ST and T-wave changes were significantly greater during coronary angiography with ioxaglate when compared with iopamidol.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J A Wisneski
- Department of Medicine, University of California, San Francisco
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Hwang MH, Murdock DK, Piao ZE, Gries WJ, Scanlon PJ. Differential hemodynamic effects of Hypaque-76 and Renografin-76 during coronary angiography: the role of calcium-binding additives. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1988; 15:5-10. [PMID: 3136927 DOI: 10.1002/ccd.1810150103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Hypaque-76 (H76) and Renografin-76 (R76) are nearly identical ionic contrast media, except that R76 binds more calcium than H76 because of the presence of sodium citrate and EDTA in R76. To determine whether the calcium-binding additives in ionic contrast media contribute to the hemodynamic effects of contrast media during coronary angiography, left coronary angiography was performed in anesthetized dogs. In nine closed-chest dogs, 10 cc of H76 and R76 were injected in each dog in a blinded, randomized fashion. The effect of H76 and R76 on left ventricular systolic pressure (LVSP) and left ventricular diastolic pressure (LVDP), on mean aortic pressure (MAP), and on left ventricular (LV) dp/dt was recorded. Compared with H76, R76 produced a greater decrease in the LVSP (77 +/- 25 mmHg vs 48 +/- 17 mmHg P less than .05), MAP (72 +/- 24 mmHg vs 38 +/- 18 mmHg P less than .01), and LV dp/dt (747 +/- 87 mmHg/sec vs 460 +/- 81 mmHg/sec P less than .01). In nine additional open-chest dogs, left coronary angiography was performed 1 hour after occlusion of the proximal LAD coronary artery. Seven cc R76 produced a 35 +/- 15 mmHg decrease in LVSP, compared with 20 +/- 9 mmHg with H76 (P less than .01). The LV dp/dt decreased 720 +/- 387 mmHg/sec with R76, compared with 462 +/- 222 mmHg/sec with H76 (P less than 0.05). Thus, R76 produces significantly greater hemodynamic abnormalities than H76. Contrast media lacking calcium-binding agents may be preferable for coronary angiography.
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Affiliation(s)
- M H Hwang
- Department of Medicine, Loyola University Medical Center, Maywood, Illinois
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Zukerman LS, Friehling TD, Wolf NM, Meister SG, Nahass G, Kowey PR. Effect of calcium-binding additives on ventricular fibrillation and repolarization changes during coronary angiography. J Am Coll Cardiol 1987; 10:1249-53. [PMID: 3119687 DOI: 10.1016/s0735-1097(87)80126-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Ventricular fibrillation during coronary angiography with Renografin-76 (meglumine sodium diatrizoate) has been attributed to the calcium-binding additives sodium citrate and sodium ethylenediaminetetraacetic acid (EDTA), which may produce repolarization changes manifested as prolongation of the QT interval. Angiovist-370 is a newer form of meglumine sodium diatrizoate that contains calcium EDTA as its additive and thus has a decreased calcium-binding effect. Eight hundred sixteen patients were prospectively randomized to receive either Renografin-76 or Angiovist-370. Ventricular fibrillation occurred in 10 of 410 patients receiving Renografin-76 and in 0 of 406 patients given Angiovist-370 (p less than 0.0005). Clinical data were analyzed without knowledge of other data in the 10 patients treated with Renografin-76 who had ventricular fibrillation (Group I), 103 randomly selected patients who also received Renografin-76 but had no ventricular fibrillation (Group II) and 108 randomly selected patients given Angiovist-370 (Group III). Of several variables examined, only the QT interval differentiated patients receiving Renografin-76 and Angiovist-370. The mean corrected QT interval (QTc interval) before coronary angiography was slightly but not significantly (p = 0.7) higher in Group I than in Groups II and III. Ten seconds after the first left coronary artery injection it was more prolonged in Groups I and II (0.552 and 0.561 second, respectively) than in Group III (0.448 second) (p less than 0.00005). Similarly, 10 seconds after the first right coronary artery injection it was significantly longer in Groups I and II (0.545 and 0.544 second) than in Group III (0.477 second) (p less than 0.00005).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L S Zukerman
- Department of Medicine, Medical College of Pennsylvania, Philadelphia 19129
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Ferguson DW, Chambers CE. Immediate balloon inflation during ventricular fibrillation complicating coronary angioplasty--an alternative technique to angioplasty system withdrawal: case reports and review. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1987; 13:125-32. [PMID: 2953433 DOI: 10.1002/ccd.1810130211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Two patients are presented in whom ventricular fibrillation occurred during otherwise uncomplicated percutaneous transluminal coronary angioplasty. Rather than withdrawing the angioplasty dilatation system in place in the coronary vessel before instituting resuscitation procedures, immediate balloon inflation was performed while a defibrillator was charged. During balloon inflation, both patients were countershocked, and they recovered stable cardiac rhythm. Postresuscitation hemodynamic and angiographic analysis revealed successful angioplasty results. This report describes an alternative technique to immediate removal of the balloon dilatation system for cardiac arrest complicating coronary angioplasty. Theoretical advantages and potential disadvantages of this technique are discussed.
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Murdock DK, Euler DE, Becker DM, Murdock JD, Scanlon PJ, Gunnar RM. Ventricular fibrillation during coronary angiography: an analysis of mechanisms. Am Heart J 1985; 109:265-73. [PMID: 3966344 DOI: 10.1016/0002-8703(85)90593-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
To investigate the mechanisms of ventricular fibrillation (VF) during coronary angiography, we assessed ventricular automaticity, local QT intervals, local conduction characteristics, and the ability to induce arrhythmias with premature ventricular stimulation in 30 dogs after intracoronary injections of 4 to 6 cc of Renografin 76 (RG 76). Ventricular automaticity was measured in six dogs as the idioventricular escape rate following intense vagal stimulation and was unchanged (51 +/- 6 vs 52 +/- 6 bpm, p greater than 0.05) with 6 cc of RG 76. In addition, 8 of 10 injections of 6 cc of RG 76 produced VF at a heart rate of 200 bpm compared to only 2 of 10 injections at a heart rate of 80 bpm (p less than 0.05). Composite and bipolar plunge electrodes were placed in the region perfused by the left anterior descending coronary artery (LAD) and circumflex coronary artery to assess QT intervals and conduction characteristics. RG 76, 4cc, produced a 116 +/- 18 msec increase in the QT intervals recorded from the region perfused by the LAD, resulting in a marked dispersion in repolarization. Both local bipolar and composite electrograms showed minimal conduction delay, which rarely extended beyond the QRS of a lead II ECG during atrial paced rhythm. As premature beats (spontaneous or induced) conducted through the region of QT prolongation, marked conduction delay was recorded from bipolar electrograms, while composite electrograms recorded continuous fractionated electrical activity spanning the diastolic interval at the onset of VF.(ABSTRACT TRUNCATED AT 250 WORDS)
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Murdock DK, Lawless CE, Loeb HS, Furiasse JG, Pagano S, Scanion PJ. Characterization of ventricular fibrillation during coronary angiography. Am J Cardiol 1985; 55:249. [PMID: 3966394 DOI: 10.1016/0002-9149(85)90350-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Murdock DK, Johnson SA, Loeb HS, Scanlon PJ. Ventricular fibrillation during coronary angiography: reduced incidence in man with contrast media lacking calcium binding additives. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1985; 11:153-9. [PMID: 3921258 DOI: 10.1002/ccd.1810110206] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The intracoronary injection of contrast media during coronary angiography occasionally results in ventricular fibrillation. Experimental studies have implicated the calcium sequestering agents, sodium citrate and EDTA in Renografin 76 (RG76), as contributing to this complication. Angiovist 370 (AV370) is a contrast medium similar to RG76 except that it contains disodium calcium EDTA instead of EDTA and sodium citrate. To determine if contrast media lacking sodium citrate and EDTA will result in a lower incidence of ventricular fibrillation in man, this investigation compared the incidence of contrast media-induced ventricular fibrillation in patients undergoing coronary angiography with RG76 to that with AV370. Group A consisted of 2,500 consecutive patients undergoing coronary angiography with RG76 and group B consisted of 2,000 subsequent consecutive patients in whom AV370 was employed as the contrast medium. There was no significant difference between groups A and B with respect to the volume of contrast media used per patient (153 +/- 49 ml vs 154 +/- 45ml), age (58.4 +/- 10 vs 58.6 +/- 10 years), sex (70% male vs 70% male), ejection fraction (59 +/- 17 vs 60 +/- 20), history of mitral valve disease (5.8% vs 7.1%), history of aortic valve disease (6.7% vs 6.5%), prior coronary artery bypass graft surgery (6.6% vs 7.3%), or extent of coronary artery disease. Fifteen episodes of contrast media-induced ventricular fibrillation occurred in group A (incidence 0.6%) whereas two episodes occurred in group B (incidence 0.1%) (p less than 0.02). Each patient was successfully defibrillated and no adverse sequelae resulted. Thus the present investigation suggests that the incidence of ventricular fibrillation during coronary angiography can be significantly decreased by using contrast media lacking sodium citrate and EDTA.
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