Comparison of Iopamidol, Ioxaglate, and Diatrizoate During Coronary Arteriography in Dogs

Thomson, Kenneth R.; Evill, Charles A.; Fritzsche, Janet; Benness, G. T.

doi:10.1097/00004424-198005000-00010

Cited by 41 publications

(12 citation statements)

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“…The prototype nonionic angiographic contrast material is metrizamide, which is essentially devoid of Na+ and has a lower osmolality for equal iodine concentration than do standard contrast agents. Metrizamide does not inhibit the myocardial ' 6 In the current study and in previous studies,8 25 2 ionic contrast media caused a drastic decline in Ca++.…”

Section: Contractile Effects In the Ischemic Statesupporting

confidence: 57%

Regional myocardial hemodynamic and metabolic effects of ionic and nonionic contrast media in normal and ischemic states.

Gerber¹,

Higgins²,

Yuh³

et al. 1982

Circulation

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SUMMARY The effects of intracoronary injection of two nonionic contrast media (iohexol and metrizamide) on myocardial contraction and chemical composition of coronary sinus (CS) blood were compared with those caused by the standard ionic contrast material for coronary angiography, sodium meglumine diatrizoate (R76), in 14 anesthetized dogs. The effects of each agent on regional contractility were compared in the normal state and in the presence of a critical coronary artery stenosis.The three contrast media produced equivalent decreases in hematocrit and sodium (both NS), but R76 caused a greater increase in CS osmolality (p < 0.02). R76 caused a significant decrease in CS potassium and ionized calcium (both p < 0.0001), but neither nonionic contrast medium caused a significant change in either potassium or calcium.In the normal state, R76 caused initial transient (< 10 seconds) increases in both end-diastolic (p < 0.006) and end-systolic segment length (p < 0.02) and a decrease in rate of change of segment length (dL/dt) (p < 0.002). The nonionic agents caused a mild increase in dL/dt (p < 0.04) and a decrease in end-systolic segment length (p < 0.03); both returned to control levels within 1 minute. In the presence of a stenosis, R76 caused a more severe and prolonged increase in end-diastolic and end-systolic segment lengths (p < 0.03) and a decrease in dL/dt (p < 0.002), which did not return to control within 2 minutes. The effects of the nonionic agents were similar in both normal and diseased states.We conclude that nonionic contrast media produce fewer alterations than ionic contrast media in coronary sinus blood chemistry and myocardial contractile state. The effect of ionic contrast media on regional contraction is accentuated in the presence of coronary artery stenosis.THE CARDIODEPRESSANT effects of intracoronary administration of iodinated contrast media have long been recognized.1-7 Several studies have implicated single-valence cations as a major factor responsible for the adverse effects on myocardial contractility.", 6-8 An imbalance in the ratio of sodium to calcium ions is also considered to be a factor, and the myocardial depression usually induced by ionic contrast media can be reversed by adding calcium ions.", 9, 10 Another approach to alleviating the myocardial toxicity of contrast media has been to develop contrast media devoid of sodium and other singlevalence cations.Metrizamide, the first nonionic contrast agent, has no sodium and approximately one-third of the osmolality of the standard ionic contrast medium and causes no negative inotropic effects. from the lyophilized form just before use. lohexol is a new nonionic contrast agent that is hydrolytically stable and has a shelf life similar to that of diatrizoate preparations.The purposes of the current study were to compare the myocardial contractile effects of nonionic contrast materials (metrizamide and iohexol) with those of the standard ionic contrast medium, sodium meglumine diatrizoate; to determine the alterations in chemical c...

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Section: Contractile Effects In the Ischemic Statesupporting

confidence: 57%

Regional myocardial hemodynamic and metabolic effects of ionic and nonionic contrast media in normal and ischemic states.

Gerber¹,

Higgins²,

Yuh³

et al. 1982

Circulation

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“…This imbalance of potassium in the coronary circulation may play a role in depressing myocardial contractility. Evaluations of left ventricular functions have revealed that ioxaglate and diatrizoate produce similar negative inotropic effects whereas iopamidol produces a positive inotropic effect (6,10). Although the etiology of the negative inotropic effects of ioxaglate and diatrizoate is obscure, since ioxaglate has a lower osmolality than iopamidol, the present results suggest that not only the prolonged decline of calcium ions but also the imbalance of potassium may produce the myocardial depression.…”

Section: Contrast Mediummentioning

confidence: 54%

“…The exact mechanism of the release of potassium from the intracellular spaces such as red blood cells is unknown, but it results in an elevated or disproportionately high potassium level compared to sodium and calcium in the coronary circulation. Previous investigations showed disproportionately high potassium levels in comparison with hemodilution and other parameters (5,10). This imbalance of potassium in the coronary circulation may play a role in depressing myocardial contractility.…”

Section: Contrast Mediummentioning

confidence: 90%

“…Assessment of changes in electrolytes in the coronary sinus during coronary arteriography is necessary in order to investigate adverse reactions due to CM, although such reactions have not been fully clarified for low-osmolality CM (1, 5,7,10). Therefore, a prospective clinical study was performed to evaluate acute electrolyte changes in the coronary sinus during left coronary arteriography.…”

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confidence: 99%

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Acute Electrolyte Disturbances in Coronary Sinus during Left Coronary Arteriography in Man

Hayakawa¹,

Mitsumori²,

Uwatoko³

et al. 1993

Acta Radiol

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Electrolyte disturbances, particularly reduction of ionized calcium, induced by iodinated contrast media (CM) are important considerations in coronary arteriography, A study was conducted in 24 patients to evaluate the acute electrolyte alterations in the coronary sinus during left coronary arteriography. During left coronary arteriography, coronary sinus blood was withdrawn for measurement of electrolytes. The CM used were diatrizoate, ioxaglate, iohexol, and iopamidol. The hematocrit was decreased moderately by all 4 CM used at 5 s and returned to the control level at 15 s. The level of ionized calcium was decreased by all CM at 5 s, Prolonged reduction of ionic calcium was observed with diatrizoate and ioxaglate at 15 s. The level of potassium was almost unchanged by diatrizoate and ioxaglate in spite of hemodilution, which may lead us to a hypothesis that potassium can be released from the intracellular spaces such as red blood cells and vascular endothelial cells, Thus the depression of left ventricular function might be caused not only by reduction of ionized calcium, but also by a relative increase in the level of serum potassium.

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“…THOMSON et coll. (9) measured electrolytes in the coronary sinus at canine coronary arteriography and found that ioxaglate produced a significant fall in calcium compared with diatrizoate. DEUTSCH et coll.…”

Section: Discussionmentioning

confidence: 99%

Effect of Contrast Media on Left Ventricular Function during Left Coronary Arteriography in Dogs

Hayakawa¹,

Yamashita²

1989

Acta Radiol

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The effect of contrast media on the left ventricular function of the heart was assessed by left coronary administration of contrast media using canine models. Following insertion of the catheter into the left coronary artery, 0.5 ml/kg of a test solution was injected at a rate of 1 mVs. The test solutions included isotonic saline, meglumine/sodium diatrizoate, iopamidol and ioxaglate. The mean systemic pressure, left ventricular end-systolic and end-diastolic pressures and the first derivative of left ventricular pressure were continuously measured until five min post-injection. Left ventricular function decreased immediately by 15 s post-injection and recovered quickly by one min. The inhibition of myocardial contractility was observed with diatrizoate and ioxaglate to the same degree. These changes were statistically more pronounced than those with iopamidol, which showed changes similar to those with saline in all parameters except for the positive inotropic effects. These observations suggest that not only hyperosmolality but also ionic composition and chemotoxicity are the factors responsible for the myocardial depression and that no single factor dominates in their effects.

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Comparison of Iopamidol, Ioxaglate, and Diatrizoate During Coronary Arteriography in Dogs

Cited by 41 publications

References 1 publication

Regional myocardial hemodynamic and metabolic effects of ionic and nonionic contrast media in normal and ischemic states.

Regional myocardial hemodynamic and metabolic effects of ionic and nonionic contrast media in normal and ischemic states.

Acute Electrolyte Disturbances in Coronary Sinus during Left Coronary Arteriography in Man

Effect of Contrast Media on Left Ventricular Function during Left Coronary Arteriography in Dogs

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