Iopamidol: a new contrast medium in coronary angiography

Meglumine sodium diatrizoate (Urografin), iopamidol, and iohexol were compared in a double-blind, randomized study of 287 patients undergoing elective cardiac angiography. Ninety-six patients received Urografin, 98 received iopamidol, and 92 received iohexol. The groups were similar in all respects. Variables measured before and after contrast injection were left ventricular end-diastolic pressure (LVEDP), left ventricular systolic pressure (LVSP), systolic arterial pressure (SAP), RR, PR, and QTc intervals, QRS duration, ST segment change greater than 2 mm, arrhythmias, and symptoms. The adequacy of coronary and ventricular opacification was assessed by two experienced observers. Following left ventriculography, small rises in LVEDP occurred with iopamidol and iohexol (mean +/- SD: 18 +/- 7 to 21 +/- 7 mmHg) and a moderate fall in LVSP with Urografin (150 +/- 32 to 133 +/- 32 mmHg). Following coronary angiography there was a progressive fall in SAP (130 +/- 26 to 117 +/- 30 mmHg) and prolongation of RR intervals (900 +/- 138 to 1,266 +/- 692 msec) and QTc (440 +/- 61 to 471 +/- 73 msec) and QRS duration (87 +/- 25 to 100 +/- 27 msec) with Urografin. There was a small fall in SAP with iopamidol (138 +/- 25 to 128 +/- 27 mmHg) and prolongation of QRS duration with iohexol (85 +/- 29 to 90 +/- 24 msec). Other parameters were not significantly affected. Frequent bradyarrhythmias (sinus pause 14.5%, asystole 6%) and ST segment depression occurred following Urografin. Urografin was less well tolerated, with 10% of patients experiencing severe nausea or vomiting and 30% of patients experiencing extreme heat sensation. Differences between iohexol and iopamidol were minor.(ABSTRACT TRUNCATED AT 250 WORDS)

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Comparison of meglumine sodium diatrizoate, lopamidol, and lohexol for coronary angiography and ventriculography

Murdock

Davis

Ireland

et al. 1990

Cathet. Cardiovasc. Diagn.

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Coronary hemodynamics during left and right coronary arteriography with an ionic and nonionic contrast medium

Schräder¹,

Sievert²,

Frey³

et al. 1988

Clinical Cardiology

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Summary:The direct effects of ionic amidotrizoate (iodine content 370 mg/ml, osmolality 2.1 osmol/kg) and nonionic iopamidol (iodine content 370/ml, osmolality 0.8 osmol/kg) on the coronary circulation were intraindividually compared in 10 patients suffering From coronary heart disease. In accordance with a double-blind, crossover protocol, both contrast media were injected into the left and right coronary arteries (8 ml and 5 ml per injection, respectively). Injections of both dyes into the left coronary artery caused a similar decrease in heart rate. The prolongation in the QT interval was significantly greater after amidotrizoate (p <0.05). Systolic (p <0.01) and diastolic (p<0.05) aortic pressures decreased to a greater extent following amidotrizoate injection. Each contrast agent produced a similar increase in coronary sinus flow, but iopamidol resulted in a smaller decrease in coronary vascular resistance @< 0.05). After right coronary artery injections, both contrast media caused bradycardia and prolongation of the QT interval, a decrease in systolic and diastolic aortic pressure, a rise in coronary sinus flow, and a lowering of coronary vascular resistance. Though most changes were more pronounced following amidotrizoate injection, the differences in the ionic and the nonionic agent were not statistically significant. Thus, after selec- tive coronary arteriography , both contrast media caused a transient drop in coronary vascular resistance and a rise in coronary sinus flow despite a decrease in aortic pressure. The effects of amidotrizoate were more marked, which might be attributed to the higher osmolality of this ionic contrast medium. Coronary hemodynamics, however, usually returned to baseline values within 1 minute. The clinical significance of the differences in the ionic and nonionic agents appears questionable.

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Transient 2:1 atrioventricular block following anaphylactic reaction to low-ionic strength computed tomography contrast agent

Mohamed

Andrade

Bayliss

et al. 2008

Canadian Journal of Cardiology

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T he present report describes a unique response following an anaphylactic reaction to a low-ionic contrast dye used for computed tomography (CT) in a patient admitted to the hospital with sepsis. A description of the case and review of the literature is presented. case presentationA 75-year-old woman with a history of chronic obstructive pulmonary disease (COPD) was admitted to the hospital following three days of pleuritic chest pain, cough and intermittent fevers. Her baseline medications included salbutamol and ipatropium. She had had a previous skin reaction to latex but had no known drug allergies.The initial examination revealed a febrile elderly woman in moderate respiratory distress. Respiratory examination demonstrated coarse crackles to the right base. Laboratory investigations confirmed mild leukocytosis with a predominance of neutrophils. Arterial blood gases demonstrated moderate hypoxia. Baseline cardiac enzymes were normal and her initial electrocardiogram showed normal sinus rhythm at 70 beats/min. A chest x-ray confirmed right lower-lobe pneumonia and the patient began treatment with intravenous moxifloxacin and vancomycin. She was admitted to the general medicine ward with a diagnosis of COPD exacerbation with community-acquired pneumonia.During the next 72 h, despite administration of intravenous (IV) antibiotics, the patient continued to have intermittent fevers. Blood cultures confirmed the presence of methacillin-sensitive staphylococcus aureus and the patient was switched to IV cloxicillin and continued on moxifloxacin. A number of investigations were performed to identify the source of sepsis. Ultimately, a bone scan identified a large paraspinal abscess from T5 to T7, and a confirmatory contrast CT of the thoracic spine was recommended to identify whether the abscess was amenable to percutaneous drainage.Unfortunately, immediately following administration of the contrast dye for the CT scan, the patient developed marked hypotension (blood pressure 80/60 mmHg), bradycardia (heart rate 40 to 45 beats/ min) and laryngeal edema. She was resuscitated with IV diphenhydramine, epinephrine and methylprednisolone sodium succinate, as well as crystalloid fluids. She was intubated and transferred to the intensive care unit.Approximately 2 h after her episode, she had an abrupt rhythm change that was noted on the cardiac monitor. Rhythm strips and a 12-lead electrocardiogram revealed a 2:1 atrioventricular block (AVB) with narrow QRS complexes and a prolonged QT interval (Figure 1). Atropine was given without an effective change in her heart rhythm. She was hemodynamically stable and, therefore, temporary pacing was deemed not necessary. The patient gradually reverted back to sinus rhythm during the next 24 h (Figure 2). She was extubated and transferred to the coronary care unit for further observation. No further episodes of AVB were noted. She completed treatment for her pneumonia and paraspinal abscess, and the rest of her hospitalization was uneventful. DiscussionWe describe a case of transient...

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Iopamidol: a new contrast medium in coronary angiography

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Comparison of meglumine sodium diatrizoate, lopamidol, and lohexol for coronary angiography and ventriculography

Comparison of meglumine sodium diatrizoate, lopamidol, and lohexol for coronary angiography and ventriculography

Coronary hemodynamics during left and right coronary arteriography with an ionic and nonionic contrast medium

Transient 2:1 atrioventricular block following anaphylactic reaction to low-ionic strength computed tomography contrast agent

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