urografin-76 and Coronary-Disease

The hemodynamic and electrophysiologic alterations induced by ionic contrast agents during cardiac angiography are well described. Recently nonionic contrast agents have become available for cardiac angiography. To evaluate the safety of these new agents, a double-blind randomized study was performed comparing a new nonionic agent (iopamidol) with a commonly used ionic contrast agent (Renografin-76). Eighty-one patients undergoing left ventriculography and coronary angiography were included; 41 received iopamidol and 40 received sodium meglumine diatrizoate (Renografin-76). After left ventriculography, there was a decrease in the arterial pressure with both contrast agents. However, the severity and the duration of hypotension were both significantly greater with Renografin-76 compared with the new nonionic agent (p less than 0.001). After selective injections of the coronary arteries, electrocardiographic analysis demonstrated that the increase in the QT interval (p less than 0.0002) and the changes in both the ST segment and T wave amplitude (p less than 0.001) were significantly greater in the Renografin-76 group compared with the iopamidol group. During coronary angiography, 8 of the 40 patients receiving Renografin-76 required temporary pacing for sinus pauses of 2.5 seconds or more, and 2 of the 40 also developed ventricular fibrillation. None of the 41 patients receiving iopamidol had these complications. This report demonstrates that the electrocardiographic changes, the severity and duration of hypotension and the incidence of serious arrhythmias are significantly greater with Renografin-76 than with iopamidol. Thus, this new nonionic agent appears to enhance the safety of cardiac angiography.

Topics: Aged; Angiocardiography; Arrhythmias, Cardiac; Clinical Trials as Topic; Contrast Media; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Double-Blind Method; Drug Combinations; Electrocardiography; Heart Valve Diseases; Hemodynamics; Humans; Iopamidol; Iothalamic Acid; Male; Middle Aged; Pain; Random Allocation; Thorax

To evaluate the myocardial metabolic effects of a new nonionic contrast agent, iopamidol, a randomized, double-blind study was performed comparing iopamidol with sodium meglumine diatrizoate (Renografin-76) in 23 patients with ischemic heart disease. Coronary sinus and arterial metabolic samples were obtained prior to and during the 20-minute period following the contrast left ventriculogram. Ten patients received iopamidol and 13 received Renografin-76. The chemical lactate extraction in the iopamidol group was 13 +/- 9% prior to left ventriculography and 17 +/- 12% following the contrast injection (p less than 0.005). In the Renografin-76 group, the lactate extraction was 23 +/- 13% and decreased significantly to 12 +/- 24% following the ventriculogram (p less than 0.01). In a subset of these patients (n = 10), [1-(14)C] lactate was infused as a tracer to quantitate the amount of lactate released by the myocardium. [1-(14)C] lactate analysis demonstrated that the fall in lactate extraction ratio following Renografin-76 was due to an increase in myocardial lactate release. In the Renografin-76 group there was a 53 +/- 37% increase in lactate release at 10 minutes after contrast agent injection (p less than 0.005), while in the iopamidol patients there was no significant change in lactate release following contrast ventriculography. The increase in lactate release in the Renografin-76 group suggests that myocardial ischemia is induced with this ionic contrast agent. In comparison, the nonionic contrast agent is less toxic to the myocardium and is not associated with the biochemical changes of cellular ischemia.

Topics: Aged; Arteries; Blood Pressure; Contrast Media; Coronary Angiography; Coronary Circulation; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Double-Blind Method; Drug Combinations; Fatty Acids, Nonesterified; Heart; Heart Rate; Heart Ventricles; Humans; Iopamidol; Iothalamic Acid; Lactates; Lactic Acid; Male; Middle Aged; Myocardium; Random Allocation

Platelet adhesion/aggregation (PAA) at a site of coronary artery stenosis is believed to be a process strongly modulated by local shear rates and the functional state of neighboring endothelium. One purpose of the present work, therefore, is to describe an in vitro model for the direct imaging of such PAA. Another is to apply the model to the question as to whether the use of nonionic vs. ionic contrast media (CM) in the presence of vascular endothelium contributes to PAA at the stenosis site. Toward these ends, we utilized a special flow chamber which incorporates a monolayer of endothelial cells (ECs), a step 66% flowpath constriction at a site preadsorbed with microfibrillar collagen, and arterial shear rates. By epifluorescence microscopy and digital image analysis of video recordings, PAA was found to be greater with dysfunctional ECs (pretreated with lysine acetylsalicyclate) than with normal ECs, thereby confirming a modulatory role in PAA of functionally intact ECs. When nonionic (iohexol) or ionic (ioxaglate, diatrizoate) CM was added to the flowing blood at a concentration of 20% by non-red cell volume, PAA was inhibited in the order diatrizoate > ioxaglate > iohexol > saline control. No inhibition by any CM was seen, however, when chamber prefill culture medium containing 20% by volume CM was displaced by CM-free blood, in simulation of bolus administration of CM. In terms of inhibition of PAA during percutaneous transluminal coronary angioplasty (PTCA), therefore, our model provides a conceptual basis by which one may anticipate in flowing blood no clear benefit of ionic over nonionic CM.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aspirin; Contrast Media; Coronary Disease; Coronary Thrombosis; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Endothelium, Vascular; Humans; In Vitro Techniques; Iohexol; Ioxaglic Acid; Lysine; Microscopy, Fluorescence; Platelet Adhesiveness; Platelet Aggregation; Platelet Aggregation Inhibitors

The myocardial distribution of both antegrade and retrograde cardioplegia for cardiac surgical intervention, after induction of cardioplegia via the aortic root, was directly assessed and compared in 19 patients by means of contrast echocardiography. Two-dimensional transesophageal echocardiographic images of the short axis of the left ventricle at the level of the papillary muscles were obtained after sonicated Renografin-76 microbubbles were injected into an aortic root and/or transatrial coronary sinus catheter during delivery of cardioplegic solution. Segmental distribution of cardioplegic solution was immediately noted in the myocardium at the time of contrast injections. In 11 of 18 patients (61%) cardioplegic solution was dispersed to all left ventricular myocardial segments after antegrade delivery. In 17 of 19 patients (90%) retrogradely delivered cardioplegic solution (after antegrade induction of cardioplegia in 18 of the 19 patients) was dispersed to all the left ventricular myocardial segments, including the septum. In 2 of the patients, initial lack of retrograde distribution of cardioplegic solution was remedied when the coronary sinus catheter was repositioned and contrast cardioplegic solution was reinjected. Imaging of the right ventricle was possible in only 4 of the 19 patients and revealed that after retrograde delivery, cardioplegic solution had been at least partially distributed to the right ventricle as well. We performed off-line videodensitometric analysis in 9 patients after retrograde delivery of cardioplegic solution. Mean peak pixel-intensity ratio of flow from the endocardium to the epicardium in the left ventricular free wall was 1.46 +/- 0.27, and mean peak pixel-intensity ratio of flow from the left to the right intraventricular septal endocardium was 1.39 +/- 0.33 (p < or = 0.05).

Topics: Aged; Aorta, Thoracic; Cardioplegic Solutions; Contrast Media; Coronary Circulation; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Echocardiography; Female; Heart Arrest, Induced; Heart Ventricles; Humans; Image Enhancement; Male; Middle Aged; Myocardium; Tissue Distribution

The influence of contrast media on thrombus formation during percutaneous transluminal coronary angioplasty was assessed in 124 consecutive patients undergoing coronary angioplasty and receiving either ionic (n = 57) (Group I) or nonionic (n = 67) (Group II) contrast medium. The presence of thrombus was assessed by qualitative analysis of angiograms in identical pre- and postangioplasty projections by four observers who had no knowledge of other data. Quantitation of stenosis severity before and after angioplasty and qualitative analysis of lesion eccentricity and complexity and of the presence of dissection were also performed. Although the baseline clinical characteristics of the two groups (including presenting syndromes and procedural and angiographic variables) did not differ, more patients in Group II than Group I developed new thrombus during coronary angioplasty (18% vs. 4%, p less than 0.02). In particular, patients with a presenting syndrome of recent myocardial infarction or rest angina, or both, and patients with an eccentric coronary plaque were more likely to develop new thrombus if they received nonionic than if they received ionic contrast medium (p less than 0.05). Patients with new thrombus formation and patients with thrombus present both before and after angioplasty had a high incidence of acute procedural complications (36% and 23%, respectively). Patients in Groups I and II had a similar incidence of ischemic events during follow-up.

Topics: Angioplasty, Balloon, Coronary; Contrast Media; Coronary Angiography; Coronary Disease; Coronary Thrombosis; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Female; Humans; Incidence; Iopamidol; Male; Middle Aged; Multivariate Analysis; Osmolar Concentration; Retrospective Studies

The hemodynamic effects induced by coronary angiography in dogs with low osmolar ionic dimer Hexabrix (HB) and nonionic Omnipaque-350 (OM) were compared to the standard ionic contrast medium, Hypaque-76 (H76), both in the normal heart and in one with simulated severe cardiac disease. Left coronary angiography was performed in 12 "normal" closed-chest dogs with 10-cc injections of H76, HB, and OM in a randomized, blinded fashion. The maximal change in the left ventricular (LV) systolic pressure (SP), mean aortic pressure (MAP), left ventricular end diastolic pressure (LVEDP), and LV dp/dt were recorded. The LVSP and MAP fell 30 +/- 3 mm Hg and 26 +/- 4 mm Hg with H76, 22 +/- 2 mm Hg and 19 +/- 2 mm Hg with HB, and 7 +/- 1.5 mm Hg and 5 +/- 1 mm Hg with OM (P less than .001). The LVEDP increased 4.8 +/- 0.5 mm Hg with H76, 3 +/- 0.5 mm Hg with HB, but only 0.2 mm Hg with OM (P less than .001). The LV dp/dt decreased 392 +/- 63 mm Hg/sec with H76 and 235 +/- 21 mm Hg/sec with HB, but increased 411 +/- 50 mm Hg with OM (P less than .001). In eight additional open-chest dogs, left coronary angiography was performed 1 hr after occlusion of the proximal LAD coronary artery and in the presence of a critical circumflex coronary artery (CX) stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Angiography; Animals; Contrast Media; Coronary Angiography; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Dogs; Drug Combinations; Female; Hemodynamics; Iohexol; Ioxaglic Acid; Male; Osmolar Concentration; Random Allocation

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)

Topics: Angiography; Animals; Blood Coagulation; Contrast Media; Coronary Angiography; Coronary Disease; Coronary Thrombosis; Diatrizoate; Diatrizoate Meglumine; Dogs; Drug Combinations; Humans; In Vitro Techniques; Iohexol; Ioxaglic Acid; Osmolar Concentration; Risk Factors

To determine whether the success of internal mammary artery bypass grafting can be assessed intraoperatively using myocardial contrast echocardiography, sonicated Renografin-76 was injected into the aortic root of 11 dogs during the delivery of cardioplegic solution. Studies were performed with the left anterior descending coronary artery patent and totally occluded, and after internal mammary artery bypass grafting distal to the occluded vessel. Flow rate during cardioplegia was constant for all three stages in each experiment. Myocardial contrast echocardiography clearly demonstrated homogeneous myocardial perfusion with the left anterior descending coronary artery patent, lack of perfusion in the left anterior descending artery bed during its occlusion and excellent perfusion of the occluded bed after internal mammary artery bypass grafting distal to the occlusion in 10 of the 11 dogs. In one dog, the bypass graft was technically inadequate and contrast opacification was not noted in the left anterior descending artery bed after internal mammary artery bypass grafting. The exponential function C(t) = Ae-alpha t + Be-beta t was fitted to computer-derived time-intensity curves from the myocardium, where alpha denotes contrast washout and beta denotes contrast appearance. Respective values for alpha and beta (mean + 1 SD) were similar for the patent left anterior descending coronary artery and after internal mammary artery bypass grafting distal to the occluded artery (0.11 +/- 0.10 versus 0.10 +/- 0.10, and 2.5 +/- 2.4 versus 1.1 +/- 0.56). In conclusion, myocardial contrast echocardiography has potential for intraoperative assessment of the adequacy of coronary artery bypass grafting.

Topics: Animals; Contrast Media; Coronary Disease; Coronary Vessels; Diatrizoate; Diatrizoate Meglumine; Dogs; Drug Combinations; Echocardiography; Image Processing, Computer-Assisted; Intraoperative Period; Myocardial Revascularization; Vascular Patency

Topics: Aged; Angioplasty, Balloon; Contrast Media; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Female; Heart Rate; Humans; Injections, Intra-Arterial; Male; Middle Aged; Time Factors

Regional function assessed by ventriculography may be influenced by the hemodynamic effects of rapidly injecting ionic contrast medium. The importance of this after acute coronary occlusion was examined in eight open-chest, anesthetized dogs. The left anterior descending artery was ligated while sonomicrometric segment lengths in the ischemic (IZ) and nonischemic zones (NZ) were measured. Sodium methylglucamine diatrizoate (Renografin-76, 1 ml/kg) was rapidly injected over 3 seconds. Fifteen minutes later, the left ventricular end-diastolic pressure (LVEDP) was rapidly increased to the level reached during injection. Injecting the contrast increased the LVEDP (7.3 +/- 2.5 to 20.1 +/- 2.9 mm Hg, p less than 0.0001) to the same extent as raising LVEDP (7.6 +/- 2.5 to 10.1 +/- 2.9 mm Hg, p less than 0.0001). Injecting the contrast medium increased IZ total percent systolic shortening (% delta L) (-3.90 +/- 4.43% to -2.68 +/- 4.77%, p less than 0.001) by decreasing isovolumic bulging (-6.68 +/- 4.09% to -5.49 +/- 3.33%, p less than 0.001) with little change in ejection % delta L. NZ total % delta L tended to increase (19.03 +/- 6.53% to 19.94 +/- 6.27%, p = 0.015) because of augmented ejection % delta L (13.12 +/- 2.51% to 13.71 +/- 3.10%, p = 0.017) by the Starling mechanism. Increasing the LVEDP had the same effect on IZ and NZ regional shortening as injecting contrast. Thus regional shortening after acute coronary occlusion is affected by the changes in loading conditions with ionic contrast ventriculography.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Contrast Media; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Dogs; Drug Combinations; Hemodynamics; Myocardial Contraction; Radiography

Densitometric regional ejection fraction obtained by computer analysis of digital subtraction ventriculography was evaluated as a new, quantitative, three-dimensional index of regional left ventricular performance. Eighteen patients with coronary artery disease and seven control subjects had right anterior oblique ventriculography at rest and immediately after rapid atrial pacing using central venous injection of contrast material. Regional left ventricular ejection fraction was determined by densitometry in six segments drawn around the end-diastolic center of gravity, and compared with two conventional indexes of segmental wall motion: area and radial regional ejection fraction. Densitometric, area or radial regional ejection fraction was classified as abnormal if it fell at least 2 standard deviations below the corresponding mean value in the normal group. The densitometric method did not require outlining of the end-systolic left ventricular silhouette and was the easiest and fastest to perform of all three techniques. In addition, intra- and interobserver reproducibilities were higher with the densitometric method (r = 0.97 and 0.95) than with either the area (r = 0.84 and 0.82) or the radial method (r = 0.82 and 0.76). Regional left ventricular dysfunction as assessed by the densitometric, area and radial techniques allowed the detection of coronary artery disease in 50, 50 and 44% of the patients at rest and in 83, 67 and 61% of the patients in the post-pacing period, respectively. Post-pacing regional left ventricular dysfunction accurately predicted the presence or absence of greater than 70% diameter stenosis in the supplying coronary artery in 75, 67 and 56% of the cases, respectively. Thus, densitometric analysis of digital subtraction ventriculography allows a fast and reproducible three-dimensional determination of regional left ventricular ejection fraction. Using this technique, pacing-induced regional dysfunction can be detected in most patients with coronary artery disease and corresponds well with the location of significant coronary artery lesions.

Topics: Absorptiometry, Photon; Cardiac Pacing, Artificial; Contrast Media; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Female; Heart; Humans; Male; Middle Aged; Radiographic Image Enhancement; Reference Values; Stroke Volume; Subtraction Technique

Contrast-enhanced ultrafast computed tomography (CT) of the left ventricle was done in the long axis and short axis within one day of cardiac catheterization in 14 males with ischemic heart disease and a mean age of 58 years. Imaging was R wave-triggered at 58-msec intervals (13/level). Left ventriculography was performed in 30 degrees right anterior oblique (RAO) and 60 degrees left anterior oblique (LAO) caudal 12 degrees. CT left ventricular ejection fraction was measured using a modified Simpson's reconstruction of end-systolic and end-diastolic slices. Catheterization left ventricular ejection fraction was measured by area-length method. Six left ventricular segments (septal, apex, anterior, lateral, inferior, and posterior) were scored by different paired observers as follows: dyskinesis (-1), akinesis (0), moderate-severe hypokinesis (1), mild hypokinesis (2), and normal (3). Correlations of left ventricular ejection fraction for catheterization vs. long-axis CT and short-axis CT were r = .83 and r = .86, respectively. Seven of eight patients with transmural myocardial infarction were identified on CT by akinetic/dyskinetic segments. Eighty-four segments were scored. There was agreement (normal vs. abnormal) in 76 (90%). CT detected 47 normal segments vs. 51 by catheterization (92%), 11 akinetic/dyskinetic segments (92%), and 14 hypokinetic segments vs. 21 (67%). Wall motion scores between CT and catheterization differed by greater than 1 in 6 of 84 segments (7%). Therefore, ultrafast CT can accurately assess global and regional left ventricular function.

Topics: Cardiac Catheterization; Contrast Media; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Heart; Humans; Male; Middle Aged; Myocardial Contraction; Stroke Volume; Tomography, X-Ray Computed

Myocardial contrast echocardiography has developed rapidly in the last few years. This paper is a review of this method based on our previous studies performed in 43 closed chest dogs. An injection of 2 ml of an agitated saline-Renografin mixture into the left main coronary artery provided contrast opacification of the entire circumference of the left ventricular myocardium. Contrast injection into the left anterior descending or the circumflex artery resulted in contrast opacification of localized regions of the left ventricle. Contrast injection into the left main coronary artery after a selective coronary artery occlusion resulted in a "negative" contrast outline of the corresponding area indicating the underperfused myocardium. The physiological and hemodynamic effects of the intracoronary injection of the contrast material appeared minor and brief. Perfusion defects after coronary artery occlusion assessed by myocardial contrast echo correlated well with those in equivalent sections by monastral blue dye injected into the left ventricle. Furthermore, the extent of myocardial necrosis after five hours of coronary occlusion assessed by myocardial contrast echo correlated well with the area of necrotic myocardium in equivocal slabs. Myocardial contrast washout index (T1/2) measured by digital intensity analysis of successive end-diastolic images was found to be significantly changed in dogs with varying degrees of coronary stenosis. Thus, the measurement of T1/2 appears to be feasible for evaluating degree of coronary stenosis, however, numerous technical problems remain to be clarified.

Topics: Animals; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Dogs; Drug Combinations; Echocardiography

This paper presents an unusual case of an individual with myocardial ischemia, angina pectoris, and myocardial infarction who also had an anaphylactic reaction to angiographic dye. The coronary bypass operation was guided by the use of intraoperative coronary reactive hyperemia assessed by Doppler ultrasound. The patient has had a good response to the operation without additional angina or difficulties.

Topics: Angina Pectoris; Coronary Artery Bypass; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Electrocardiography; Female; Humans; Middle Aged; Myocardial Infarction; Ultrasonics

Recent studies suggest that angiographic measurements of coronary arterial stenosis are poorly correlated with direct measurements of the capacity of the artery to conduct hyperemic blood flow. Direct measurement of coronary blood flow and the flow reserve capacity of individual coronary vessels in conscious humans, however, has been hampered by methodologic limitations. We have developed and validated a coronary Doppler catheter capable of subselectively measuring coronary blood flow velocity at the time of cardiac catheterization. Studies in seven calves demonstrated that measurements of the change in coronary blood flow velocity assessed using the Doppler catheter were highly correlated with simultaneous measurements of the change in coronary sinus blood flow (r = 0.97, slope = 1.06) and changes in blood flow velocity assessed using an epicardial Doppler probe (r = 0.95, slope = 1.04). Additional studies demonstrated that the catheter did not produce physiologically significant obstruction to coronary blood flow. Subsequent studies in 215 humans undergoing catheterization have shown that acceptable signals of phasic coronary blood flow velocity could be recorded in 176 patients. Subsequent dose response kinetic studies demonstrated that intracoronary administration of papaverine can rapidly produce maximal coronary hyperemia, equivalent in magnitude to intravenous dipyridamole, but short enough in duration to permit multiple measurements of coronary flow reserve during a single catheterization. Measurements of coronary flow reserve in patients with obstructive coronary artery disease have permitted characterization of the physiologic significance of individual obstructive coronary lesions. The development of this coronary Doppler catheter system and technique for measurement of maximal coronary flow reserve should facilitate characterization of the physiologic impact of coronary arterial lesions on coronary blood flow and studies of the coronary circulation in conscious humans.

Topics: Animals; Blood Flow Velocity; Cardiac Catheterization; Cattle; Coronary Circulation; Coronary Disease; Coronary Vessels; Diatrizoate; Diatrizoate Meglumine; Dipyridamole; Drug Combinations; Echocardiography; Humans; Papaverine; Vasodilation

Measurement of coronary flow reserve has been suggested as an adjunct to anatomic assessment of coronary stenoses in patients with ischemic heart disease. We compared papaverine hydrochloride and radiographic contrast to determine which agent was superior for the determination of coronary flow reserve. Coronary flow reserve was determined during cardiac catheterization by means of digital coronary angiography and parametric imaging. Two groups of patients were studied. Among patients in group 1, coronary flow reserve was determined by means of both papaverine and contrast. In group 1 patients with normal coronary arteries, papaverine-induced flow reserve was greater than contrast-induced reserve in all but one vascular region (n = 9, 4.98 +/- 1.15 vs 3.56 +/- 0.89; p = 0.29). Group 1 patients with coronary disease also demonstrated significantly greater flow reserve with papaverine (n = 25, 2.57 +/- 0.20 vs 1.83 +/- 0.11, p less than 0.01). Group 2 included patients with single-vessel coronary artery stenoses. These patients were studied by means of either papaverine or contrast to determine coronary flow reserve for both the stenotic "ischemic" region and an adjacent nonstenotic, "nonischemic" region. Those patients in group 2 who were studied by means of contrast had a modest difference between flow reserve values in the nonischemic and those in the ischemic regions (n = 15, 1.78 +/- 0.10 vs 1.26 +/- 0.09; p less than .0001) with considerable overlap. Patients studied by means of papaverine had a much greater separation in flow reserve between nonischemic and ischemic regions (n = 22, 2.78 +/- 0.19 vs 1.46 +/- 0.14; p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Blood Flow Velocity; Cardiac Catheterization; Cineradiography; Contrast Media; Coronary Angiography; Coronary Circulation; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Drug Evaluation; Humans; Hyperemia; Papaverine; Retrospective Studies

To define the in vivo relation between abnormal wall motion and the area at risk for necrosis after acute coronary occlusion, 11 open chest dogs were studied. Five dogs underwent left anterior descending coronary artery occlusion and six underwent left circumflex artery occlusion. Area at risk was defined at five short-axis levels (mitral valve, chordal, high and low papillary muscle and apex) using myocardial contrast echocardiography. Wall motion was measured in the cycles preceding injection of contrast medium. Two observers used two different methods to measure wall motion. In method A, end-diastolic to end-systolic fractional radial change for each of 32 endocardial targets was determined. The extent of abnormal wall motion was then calculated using three definitions of wall motion abnormality: akinesia/dyskinesia, fractional inward endocardial excursion of less than 10%, and fractional inward endocardial excursion of less than 20%. In method B, the information from the entire systolic contraction sequence was analyzed and correlated with a normal contraction pattern. The best linear correlation between area at risk (AR) and abnormal wall motion (AWM) was achieved using method B and expressed by the following linear regression: AWM = 0.92 AR + 3.0 (r = 0.92, p less than 0.0001, SEE = 1.7%). Of the three definitions of abnormality used in method A, the best correlation was achieved between area at risk and less than 10% inward endocardial excursion and was expressed by the following polynomial regression: AWM = -0.01 AR2 + 1.5 AR -0.14 (r = 0.92, p less than 0.001, SEE = 1.7%). These data demonstrate that there is a definite relation between area at risk and abnormal wall motion but that this relation varies depending on the method used to analyze wall motion. However, wall motion during acute ischemia is also influenced by the loading conditions of the heart. Because these may vary in a manner that is independent of the ischemic process, measurement of both risk area and abnormal motion may provide a more comprehensive assessment of cardiac function in myocardial ischemia than is provided by the measurement of either alone.

Topics: Animals; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Dogs; Drug Combinations; Echocardiography; Heart; Movement; Necrosis; Risk

Intravenous injections of ionic contrast media increase extravascular lung water in patients with elevated left atrial pressure, particularly in the presence of myocardial ischemia. The authors compared bolus injections of sodium methylglucamine diatrizoate and iopamidol on extravascular lung water at several levels of left atrial pressure in dogs. Methylglucamine increased lung water by a maximum of approximately 25-30% above baseline levels at low (less than 3 mm Hg), moderate (approximately equal to 15 mm Hg), and elevated left atrial pressures (greater than or equal to 25 mm Hg). At matched pressures, the peak change in lung water in the dogs given iopamidol was +4%, +7%, and +6%, respectively. In dogs with myocardial ischemia, the differences were even more pronounced (+45%, +60%, and +70%, respectively, for ionic media, and +7%, +12%, and +21% for iopamidol). The authors caution against using ionic contrast media in patients with left ventricular dysfunction, particularly associated with ischemia. In such cases, non-ionic media appear safer.

Topics: Animals; Capillary Permeability; Cardiac Output; Contrast Media; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Dogs; Drug Combinations; Extracellular Space; Hypertension; Iopamidol; Iothalamic Acid; Lung; Risk; Stimulation, Chemical

Sequential measurement of QT interval during left ventricular angiography was made 30 seconds and one, three, five and ten minutes after injection of hypaque 76. The subjects were ten patients found to have normal left ventricles and coronary arteries. Significant QTC prolongation occurred in 30 seconds to one minute in association with marked hypotension and elevation of cardiac output.

Topics: Arrhythmias, Cardiac; Contrast Media; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Electrocardiography; Heart Ventricles; Humans; Radiography; Risk; Ventricular Fibrillation

Myocardial contrast echocardiography has been shown recently to accurately assess the "area at risk" for necrosis after acute coronary occlusion in the experimental model. Risk area quantitation, however, has been studied primarily from single tomographic planes. Because the three-dimensional extent of myocardial necrosis depends on the total volume of myocardium at risk, the total left ventricular "area at risk" was determined in 11 dogs (Group A) with either left anterior descending or left circumflex artery occlusion using contrast echocardiography and compared with risk area determined by technetium autoradiography. An excellent correlation was found between the two methods (r = 0.96%, y = 0.91x + 1.5, p less than 0.001, SEE = 3.17). A comparison of risk area for individual levels of the left ventricle using both methods, however, showed some variation in the degree of correlation, with the poorest fit being apparent at the apex. To identify the source of the variation, errors caused by data registration were minimized in six additional dogs (Group B) by implanting epicardial markers at a single level and measuring "area at risk" at this level using both methods. When no registration error was present, the correlation between the two methods was excellent (r = 0.99, y = 0.92x + 2.6, p less than 0.001, SEE = 0.55). In conclusion, the "area at risk" for infarction after acute coronary occlusion can be determined accurately for the entire left ventricle as well as for a single tomographic slice using myocardial contrast echocardiography. This was validated using technetium autoradiography, which is an established method of determining "area at risk" in the experimental setting.

Topics: Animals; Contrast Media; Coronary Circulation; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Diphosphates; Dogs; Drug Combinations; Echocardiography; Microspheres; Myocardium; Radioisotopes; Scandium; Technetium; Technetium Tc 99m Pyrophosphate

A modification of the standard percutaneous transluminal coronary angioplasty (PTCA) procedure is described using a power injector instead of a hand-held syringe for distal coronary contrast injections. This system was used in 215 dilatations without complications related to the power injector. We found this system to simplify the PTCA procedure and allowed for improved distal visualization even with the steerable PTCA catheters containing an intraluminal guide wire.

Topics: Angioplasty, Balloon; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Humans; Radiographic Image Enhancement

Intravenous injections of ionic contrast media are widely used in the performance of radiographic techniques. The effects of ionic contrast media on lung water are unclear in the setting of elevated left atrial pressure, particularly in the presence of myocardial ischemia. In this study, we examined the effects of bolus injections of intravenous sodium meglumine diatrizoate (Renografin 76, 1 ml/kg, injected at 20 ml per second) on measures of extravascular lung water (EVLW) at several levels of left atrial pressure and in the presence of myocardial ischemia. Bolus injections of Renografin 76 produced significant increases in EVLW, with similar mean peak increases of approximately 26% EVLW at low (initial pressure less than 3 mm Hg), moderate (approximately 15 mm Hg), and elevated left atrial pressures (approximately 25 mm Hg). At matched pressures, the peak change in EVLW in the ischemic dogs was +45%, +60%, and +70%, respectively (all P less than .001 vs. the nonischemic dogs). Thus, use of intravenous ionic media precipitated acute transient increases in lung water, which were exaggerated by myocardial ischemia. While the effects were time limited in this experimental model, caution is advised in using intravenous ionic media in patients who have left ventricular dysfunction, particularly if underlying ischemia is present.

Topics: Animals; Blood Pressure; Cardiac Catheterization; Cardiac Output; Contrast Media; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Dogs; Drug Combinations; Extracellular Space; Heart Atria; Hypertension; Injections, Intravenous; Lung; Time Factors

Coronary venous injections of sonicated Renografin-76 were performed in seven closed chest dogs during two-dimensional echocardiography to study the ability of this new technique to opacify regional myocardium before and after occlusion of the left anterior descending coronary artery. The balloon of a 4F double lumen catheter was inflated in the great cardiac vein for each contrast injection to prevent backflow through the coronary sinus into the right atrium. Retrograde injections before coronary artery occlusion generally resulted in patchy myocardial contrast uptake. Injections after coronary occlusion always resulted in confluent and transmural myocardial opacification which occupied 42.8 +/- 8.6% (range 26 to 54) (mean +/- standard deviation) of the myocardial circumference. Retrograde opacification always extended into adjacent myocardium beyond the ischemic zone, which was assessed in echocardiograms with antegrade contrast injections into the left main coronary artery and which measured 30 +/- 6.3% of the ventricular circumference. Shunting from the coronary venous system to cardiac chambers was evaluated in a parasternal four chamber view and was graded on a scale of 0 to 4+. Contrast appearance was equally intense in the right atrium and right ventricle (3.5 +/- 0.6+, range 2+ to 4+), less intense in the left ventricular cavity (1.5 +/- 0.6+, range 1+ to 3+) and absent in the left atrium. Postmortem anatomic validation with retrograde great cardiac vein injections of indocyanine green corroborated and in vivo contrast appearance in chambers. Retrograde coronary venous contrast echocardiography appears capable of providing in vivo information about the extent and location of myocardial zones that can be reached by retrograde infusions of therapeutic agents and about the ability of these agents to reach ischemic myocardium. In addition, this new method allows for in vivo evaluation of shunts between coronary veins and cardiac chambers, which may influence the efficacy of retrograde interventions.

Topics: Animals; Cardiac Catheterization; Contrast Media; Coronary Circulation; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Dogs; Drug Combinations; Echocardiography; Myocardium

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

Topics: Adult; Aged; Coronary Angiography; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Electrocardiography; Female; Heart Rate; Humans; Male; Middle Aged; Saline Solution, Hypertonic

Since myocardial infarction is the major cause of perioperative and postoperative death following peripheral vascular surgery, an accurate method of screening for coronary artery disease in this group of patients is needed. Digital subtraction angiography (DSA) with the use of intra-arterial aortic root injection of contrast material was evaluated as a method of screening for coronary artery disease in patients undergoing angiography for peripheral vascular disease. The feasibility of this method was demonstrated in animal experiments. Fifteen milliliters of Renografin-76 was power injected into the aortic root of seven anesthetized 20 kg mongrel dogs. Normal coronary artery anatomy was clearly demonstrated with DSA, and a series of iatrogenically created stenoses and occlusions were accurately identified. Excellent definition of patent grafts to the left anterior descending and circumflex coronary arteries was obtained in two dogs that had undergone previous coronary artery bypass grafting. A balloon occluder on one graft was used to demonstrate partial and near-total obstruction of the bypass graft. We are currently studying the use of aortic root injections using DSA to determine coronary artery disease in patients having standard angiography for peripheral vascular disease. Adequate visualization of coronary arteries and bypass grafts with only 20 ml of contrast has been obtained. The potential ability of this technique to identify and allow treatment of life-threatening coronary artery lesions in patients prior to or simultaneously with peripheral vascular surgery may result in reduced mortality.

Topics: Angiography; Animals; Aorta, Thoracic; Coronary Artery Bypass; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Dogs; Drug Combinations; Humans; Injections, Intra-Arterial; Subtraction Technique; Vascular Diseases

Topics: Adult; Aged; Angiography; Cardiac Catheterization; Cardiac Volume; Cineangiography; Computers; Contrast Media; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Female; Heart Ventricles; Humans; Injections, Intravenous; Male; Middle Aged; Stroke Volume

Contrast media used during angiography are known to produce transient alterations in cardiovascular physiology. However, little information is available concerning what alterations, if any, occur in myocardial metabolism after contrast angiography. Sixteen patients with symptoms of ischemic heart disease undergoing elective left ventriculography were studied. Coronary sinus and arterial blood samples were obtained for free fatty acids, glucose and lactate before and after performing left ventriculography with Renografin-76. Coronary blood flow was determined by the thermodilution technique. Five minutes after ventriculography, the arterial level of free fatty acids had decreased by 18.0 +/- 4.9 percent (mean +/- standard deviation) from the baseline (before angiography) samples (probability [p] less than 0.001). Associated with this decrease in arterial free fatty acids was an increase in the myocardial uptake of this substrate. At 5 minutes after left ventriculography, the free fatty acid uptake had increased 48.5 +/- 33.0 percent compared with the baseline value (p less than 0.001). After the injection of contrast medium, there was no significant change in the arterial levels of glucose or lactate. However, significant decreases in the myocardial uptake of glucose and lactate were demonstrated (-72.5 +/- 44.5 percent [p less than 0.001] and -43.2 +/- 22.9 percent [p less than 0.001], respectively) at 5 minutes. The changes in arterial free fatty acids and in the myocardial uptake of the various substrates persisted throughout the sampling period of 20 minutes after ventriculography. These results demonstrate that contrast medium significantly alters myocardial metabolism. These metabolic alterations persist longer than the hemodynamic changes induced by contrast angiography.

Topics: Angiography; Blood Glucose; Contrast Media; Coronary Circulation; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Fatty Acids, Nonesterified; Heart; Humans; Lactates; Lactic Acid; Male; Myocardium; Time Factors

The effects of intracoronary diatrizoate meglumine and diatrizoate sodium (Renografin-76) on regional contraction were examined in the normal coronary circulation and during partial (50 percent) coronary occlusion in 11 dogs using strain and length gauges. Intracoronary injections of Renografin-76 (1.5 cc) (1.690 mosM/liter; 0.19 mEq Na/ml), equiosmolar dextrose solution and 0.19 mEq Na+/ml saline solution were made randomly. Renografin-76 caused a decrease in preejection tension to 87.4 +/- 4.3 percent (p less than 0.025), total tension to 74.6 +/- 3.3 percent (p less than 0.01) and ejection tension to 11.9 +/- 12.6 percent (p less than 0.001) of control value. Segment length increased to 106.7 +/- 7.3 percent of control value. These changes lasted only 12 +/- 2 (range 5 to 20) seconds (mean +/- standard error of the mean). During partial coronary occlusion and after injection of Renografin-76, preejection tension decreased from 91.7 +/- 6.3 to 53.8 +/- 3.9 percent (p less than 0.01), total tension from 89.9 +/- 5.0 to 59.7 +/- 3.5 percent (p less than 0.01) and ejection tension from 22.8 +/- 8.1 to 17.8 +/- 10.9 percent, whereas segment length increased from 112.7 +/- 3.7 to 130.7 +/- 4.6 percent (p less than 0.01) of control value. In contrast to findings in the normal coronary circulation, tension and length changes lasted 54 +/- 16 (range 15 to 180) seconds (p less than 0.05). The hyperemic response during normal coronary circulation was completely abolished during partial coronary occlusion. Prior administration of nitroglycerin did not shorten the duration of the myocardial depressant effects of Renografin. Injections of equiosmolar dextrose or saline solution produced qualitatively similar but quantitatively less marked changes. Thus, intracoronary Renografin-76 has an accentuated and prolonged depressant effect on the ischemic as compared with the normally perfused myocardium; this effect is not solely due to its hyperosmolarity or sodium concentration.

Topics: Animals; Arterial Occlusive Diseases; Blood Pressure; Coronary Disease; Coronary Vessels; Diatrizoate; Diatrizoate Meglumine; Dogs; Drug Combinations; Glucose; Heart; Heart Rate; Nitroglycerin; Sodium Chloride