Hemodynamic and electrocardiographic consequences of high‐ and low‐osmolality contrast agents for left ventricular angiography

Vik‐Mo, Harald; Rosland, Gunnar Alm; Følling, Magne; Daníelsen, Ragnar

doi:10.1002/ccd.1810140302

Cited by 19 publications

(3 citation statements)

References 31 publications

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“…Similar pressure increases have been described by several authors for lowosmolar contrast agents [5,10,12,31,38]. The immediate and simultaneous decreases in left ventricular systolic pressure, aortic pressures and systemic vascular resistance are consistent with a rapid and transient vasodilatory effect of contrast agents that has been shown in several studies [1,2,4].…”

Section: Other Hemodynamic Variablessupporting

confidence: 68%

“…Several mechanisms have been proposed for the contrast-induced increase in LVEDP, such as expansion of the plasma volume, depression of contractility, decreased myocardial compliance, and an increased arterial pressure that may be due to a reflex sympathetic stimulation [4,10,36]. It is more likely that systemic rather than myocardial effects are involved, because Mancini et al, found no increase in LVEDP during coronary angiography even with high-osmolar contrast media [37].…”

Section: Main Trial Parameter: Lvedpmentioning

confidence: 93%

“…These effects have been explained by factors that include high osmolality, high sodium concentration, chemical toxicity of the contrast molecule and calcium binding properties of the chelates used for some of these agents [1,6]. Contrast agents with a lower osmolality (ionic dimeric or nonionic monomeric agents) have much less pronounced hemodynamic effects [1,2,[7][8][9][10][11][12]. This has been assumed to reduce the risk of provoking myocardial ischemia during coronary angiography or ventriculography [13].…”

Section: Introductionmentioning

confidence: 99%

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Hemodynamic effects of iodixanol and iohexol during ventriculography in patients with compromised left ventricular function

Bergstra

Dijk

Brekke³

et al. 2000

Cathet. Cardiovasc. Intervent.

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A crossover study was performed to compare the hemodynamic effects of the iso-osmolar contrast agent iodixanol (Visipaque) 320 mg I/ml to those of the low-osmolar iohexol (Omnipaque) 350 mg I/ml. The main hypothesis was that iodixanol and iohexol would affect left ventricular end-diastolic pressure (LVEDP) to different degrees. In 48 patients with reduced cardiac function (mean ejection fraction 33. 4%), one ventricular injection was performed with each contrast medium. Ventricular, aortic and right atrial pressures and heart rate were measured continuously. Cardiac output (using Fick's principle) and systemic vascular resistance were calculated. LVEDP increased with both agents, but significantly less after iodixanol than after iohexol (P < 0.01), also in subgroups of patients in whom baseline LVEDP was severely increased and in whom 3-vessel disease was present. Immediate changes in variables reflecting vasodilatation were similar with both agents. In conclusion, both contrast agents influenced hemodynamics during ventriculography, but iodixanol had significantly less influence on LVEDP than did iohexol.

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Section: Other Hemodynamic Variablessupporting

confidence: 68%

Section: Main Trial Parameter: Lvedpmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hemodynamic effects of iodixanol and iohexol during ventriculography in patients with compromised left ventricular function

Bergstra

Dijk

Brekke³

et al. 2000

Cathet. Cardiovasc. Intervent.

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The potential risk of thrombosis during coronary angiography using nonionic contrast media

Hwang

Piao

Murdock

et al. 1989

Cathet. Cardiovasc. Diagn.

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The influence of contrast media on coagulation has an important association with thromboembolic complication during coronary angiography. In this study, whole blood was methodically mixed with nonionic contrast medium, Iohexol (IOH), conventional ionic contrast medium, Hypaque-76 (H76), and low osmolar ionic dimer Hexabrix (HB) in vitro. The thrombotic propensity of contrast agents can be evaluated by measuring the clot formation of the mixtures. The experiments were repeated with whole blood after systemic heparinization. In the in vitro study, 5 ml of canine (N = 10) and 3 ml of human (N = 11) whole blood was incubated for 30 min in glass tubes with equal volumes of IOH, H76, HB, and 0.9% NaCl before heparinization. Clot formation with IOH and 0.9% NaCl were seen both in dogs (4.0 +/- 0.7 gm and 5.6 +/- 0.8 gm) and in patients (1.4 +/- 0.9 gm and 2.9 +/- 1.3 gm), whereas no clot was seen with H76 or XB. Following heparinization, no clot was visualized in any mixture of whole blood with contrast media or 0.9% NaCl. Similar results were observed in the catheter-syringe system with canine blood (N = 11) mixed with the contrast agents. Blood clots found in 15 min and 30 min of IOH were 0.07 +/- 0.08 gm and 0.44 +/- 0.20 gm (P less than 0.01) and of NaCl were 0.29 +/- 0.37 gm and 0.69 +/- 0.38 gm (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

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Influence of low osmolality contrast media on electrophysiology and hemodynamics in coronary angiography: Differences between an ionic (loxaglate) and a nonionic (lohexol) agent

Vik‐Mo

Følling

Barth

et al. 1990

Cathet. Cardiovasc. Diagn.

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It has recently been suggested that the addition of sodium to low osmolality contrast media may reduce the incidence of ventricular fibrillation and conduction disturbances during coronary angiography. In a randomized, double blind study of 30 patients undergoing coronary angiography we therefore examined the electrophysiological and hemodynamic effects of the two low osmolality contrast media-ioxaglate (with sodium) and iohexol (without sodium). Standard ECG, aortic blood pressure, and His bundle electrocardiogram were recorded. The contrast media were well tolerated and no serious arrhythmias were observed. Both induced a transient decrement in systolic blood pressure and reduction in heart rate 10 s following contrast injection (all P less than 0.01). Ioxaglate prolonged the QT interval at 10 s (P less than 0.01) and also when analysed for the whole observation period (120 s) (P less than 0.05), whereas iohexol did not cause any significant changes in the QT-interval. The AH-interval was prolonged by ioxaglate at 10 s (P less than 0.01), but not altered by iohexol. Thus, other factors than osmolality and sodium content might contribute to QT prolongation, since only the contrast agents with sodium (ioxaglate) induced QT prolongation in this study.

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Hemodynamic and electrocardiographic consequences of high‐ and low‐osmolality contrast agents for left ventricular angiography

Cited by 19 publications

References 31 publications

Hemodynamic effects of iodixanol and iohexol during ventriculography in patients with compromised left ventricular function

Hemodynamic effects of iodixanol and iohexol during ventriculography in patients with compromised left ventricular function

The potential risk of thrombosis during coronary angiography using nonionic contrast media

Influence of low osmolality contrast media on electrophysiology and hemodynamics in coronary angiography: Differences between an ionic (loxaglate) and a nonionic (lohexol) agent

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