iothalamate-meglumine and Coronary-Disease

The incidence of cardiac arrhythmias in patients with coronary artery disease receiving intravenous contrast medium has been studied and comparison made between a conventional ionic medium (meglumine iothalamate) and a low osmolar medium (sodium meglumine ioxaglate). Occasional ventricular and atrial ectopics were frequently observed both before and during administration of the contrast medium and were regarded as insignificant. Significant arrhythmias occurred in five cases. Three of these however, were in the presence of acute myocardial ischaemia or recent infarction. There was no significant difference in the incidence of arrhythmias between the two contrast media. These results show that, in the absence of acute myocardial ischaemia, the incidence of life threatening arrhythmias in patients with proven coronary artery disease receiving intravenous contrast media is much lower than previously suspected.

Topics: Arrhythmias, Cardiac; Coronary Disease; Humans; Infusions, Intravenous; Iothalamate Meglumine; Ioxaglic Acid; Radiography

Forty consecutive patients with coronary artery disease undergoing left ventricular angiography took part in a randomised double blind trial comparing a conventional contrast medium sodium meglumine iothalamate (Cardio-Conray) with the low osmolar agent iopamidol. Iopamidol produced a smaller rise in heart rate and a smaller fall in left ventricular systolic pressure, but the changes in left ventricular and diastolic pressure and maximum rate of change of pressure (dP/dt max) were not different. The numbers of extrasystoles per minute for five minutes after ventriculography were similar in both groups except for the first 15 seconds, when the number of extrasystoles was increased in the iopamidol group. The frequency and magnitude of symptoms (heat, angina, headache, nausea) were significantly different in two groups. Iopamidol caused less haemodynamic disturbance than Cardio-Conray, although the improvement is small and offers no advantage in reducing symptoms or extrasystoles.

Topics: Angiocardiography; Cardiac Complexes, Premature; Clinical Trials as Topic; Contrast Media; Coronary Disease; Double-Blind Method; Female; Heart Rate; Hemodynamics; Humans; Iopamidol; Iothalamate Meglumine; Iothalamic Acid; Male; Middle Aged; Random Allocation

We compared Hexabrix 320 (580 mOsm kg-1) with Conray 420 (2500 mOsm kg-1) for left ventriculography using a prospective randomised double-blind protocol. One hundred consecutive patients with suspected coronary disease were assigned to Hexabrix (52) or Conray (48) for left ventriculography (dose 10 ml m-2 BSA; flow rate 12 ml s-1). Thirteen patients found Hexabrix unpleasant compared with 24 receiving Conray; overall the feelings of warmth and discomfort were less with Hexabrix than Conray (p less than 0.01 and p less than 0.02 respectively). The incidence of nausea, vomiting, and hypersensitivity was similar. Angiographic quality was better with Conray than with Hexabrix (p less than 0.05). Average changes in heart rate and systolic pressure were similar, though there was greater variation in systolic pressure change after Conray (p less than 0.025). End diastolic pressure increased more after Conray than after Hexabrix (p less than 0.05). These slight advantages of Hexabrix over Conray may be valuable in patients requiring multiple angiograms or in those with impaired cardiac function, but do not justify its use for routine angiography.

Topics: Adult; Aged; Blood Pressure; Clinical Trials as Topic; Contrast Media; Coronary Disease; Female; Headache; Heart Rate; Humans; Iodobenzoates; Iothalamate Meglumine; Ioxaglic Acid; Male; Middle Aged; Osmolar Concentration; Radiography; Triiodobenzoic Acids

In eighty patients with different cardiac diseases the theoretically claimed reduced cardiovascular side effects in ionic and non-ionic low osmolar contrast media compared to those in conventional ionic and high-osmolar contrast media were tested during heart catheterization. The randomized application showed that there were only few reactions during left ventricle angiography and they did not differ between various ejections, while during selective coronary angiography in most cases heart rate and aortic pressures dropped significantly (p less than 0.05). These alterations were significantly (p less than 0.05) stronger in the conventional ionic and high-osmolar ioxitalamat (Telebrix 350) than in the ionic and non-ionic low-osmolar ioxaglat (Hexabrix) or non-ionic low-osmolar iopamidol (Solutrast 370).

Topics: Adult; Aged; Angiography; Cardiomyopathies; Contrast Media; Coronary Angiography; Coronary Disease; Female; Heart Diseases; Heart Valve Diseases; Heart Ventricles; Hemodynamics; Humans; Iodobenzoates; Iothalamate Meglumine; Ioxaglic Acid; Male; Middle Aged; Triiodobenzoic Acids

The radiopacity and complications of meglumine iothalamate 52% and sodium iothalamate 26% (Vascoray) were compared with those of meglumine diatrizoate 66% and sodium diatrizoate 10% (Renografin -76) in 2258 patients with and without cardiac disease. There was no difference in radiopacity and the type and incidence of adverse reactions were similar, but the frequency was significantly higher (p less than 0.05) with Vascoray in patients with constrictive pericarditis, dissecting aortic aneurysm, and primary pulmonary hypertension. The difference in the frequency of hypotension, sinus bradycardia, and transient asystole in the Renografin -76 and Vascoray groups was statistically significant. Ventricular arrhythmias occurred in 6% of the patients with primary myocardial disease compared to an average of 0.7% in those without this cardiac abnormality (p less than 0.01), but there was no significant difference in the frequency in the two contrast agent groups. All reactions were treated and the studies were performed without mortality. Results of this study show that iothalamate formulation with sodium to meglumine ratio of 1:2 containing 410 mEq/L of sodium (Vascoray) is suitable and safe for clinical use for roentgenographic studies of the heart, and coronary artery circulation.

Topics: Adult; Aged; Cardiac Catheterization; Cardiomyopathies; Contrast Media; Coronary Angiography; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Female; Heart Defects, Congenital; Humans; Iothalamate Meglumine; Iothalamic Acid; Male; Middle Aged; Rheumatic Heart Disease

Iopamidol, a new non-ionic water-soluble contrast medium, has been compared with standard ionic media in a number of cardiovascular applications. It is stable in aqueous solution, is much less viscous and only slightly more osmolar than metrizamide. Compared to sodium meglumine diatrizoate in a series of 40 coronary arteriograms, it produced a consistent and highly significant decrease in the incidence and severity of hypotension and bradycardia following intracoronary injection. In the same group and in 62 children undergoing ventricular or great vessel angiocardiography, a subjective assessment of patient reaction showed that iopamidol was better tolerated than the ionic medium. There was a very strong patient preference for iopamidol in a group of 20 of the adult patients who had also consented to femoral artery injections of both media. Throughout these series there was no detectable difference in arterial image quality between the media. Venous phase opacification during arterioportography was assessed in 11 cases comparing iopamidol with sodium meglumine iothalamate. No significant difference was found. We conclude that iopamidol is clearly preferable to ionic media for routine cardiovascular applications.

Topics: Angiocardiography; Child; Contrast Media; Coronary Disease; Diatrizoate Meglumine; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Iopamidol; Iothalamate Meglumine; Iothalamic Acid; Portal Vein; Viscosity