urografin-76 and Heart-Diseases

Contrast agents used for cardiac angiography are different in regard to ionicity, osmolality and physiologic effects. The nonionic contrast media have been shown to have less toxic effects and a better safety profile than do higher osmolar agents. To better assess this risk, clinically stable patients undergoing cardiac angiography were stratified according to the presence of diabetes mellitus, and level of serum creatinine, and then randomized to receive either iohexol (Omnipaque 350) or sodium meglumine diatrizoate (Renografin 76). All adverse events that occurred during and immediately after angiography were tabulated. A multivariate model was used to identify patients at increased risk for adverse outcome. The 1,390 patients were randomized to iohexol (n = 696) or diatrizoate (n = 694). Significant differences were found in the number of patients with contrast media-related adverse (iohexol vs diatrizoate: 10.2 vs 31.6%; p < 0.001) and cardiac adverse (7.2 vs 24.5%; p < 0.001) events. Severe reactions and the need for treatment were more frequent with diatrizoate than with iohexol, but there was no difference in the incidence of death. The presence of New York Heart Association classification 3 or 4 and serum creatinine > or = 1.5 mg/dl predicted a higher incidence of adverse events as a result of contrast media alone. Use of iohexol is associated with a lower incidence of all types of adverse events during cardiac angiography than is diatrizoate.

Topics: Adult; Aged; Aged, 80 and over; Angiocardiography; Cardiovascular Diseases; Contrast Media; Creatinine; Diabetes Complications; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Female; Heart Diseases; Humans; Iohexol; Logistic Models; Male; Middle Aged

Topics: Animals; Diatrizoate; Diatrizoate Meglumine; Dogs; Drug Combinations; Heart Diseases; Spectrometry, X-Ray Emission; Swine

We evaluated ultrafast CT as a method to measure left ventricular ejection fraction in 16 adults with congenital or acquired heart disease who underwent cardiac catheterization. CT scanning of the left ventricle was performed at 4 to 12 adjacent 1 cm levels (depending on heart size) at 50 msec/scan for one cardiac cycle, with the table positioned with an axial tilt of 10 to 20 degrees and a lateral slew of 5 to 10 degrees to best approximate the long axis of the left ventricle. Image enhancement was achieved by an injection of 25 ml of Renografin-76 via a peripheral vein, with scanning timed to coincide with maximal enhancement of the left ventricular cavity. Ejection fraction was computed by measuring the percent change in area of the left ventricle from diastole (largest area) to systole (smallest area) in a single slice at the mid-left ventricular level. Mean ejection fraction for the group was 58.1 +/- 15.1% (range 24% to 84%). The ejection fraction from left ventriculography, computed from biplane images using the Dodge (area-length) formula, was 59.6 +/- 12.3% (range 28% to 77%). There was an excellent correlation between left ventricular ejection fraction by CT and ventriculography (r = 0.91, y = 1.1x - 8.5, p less than 0.001). This study demonstrates that ultrafast CT can provide an accurate measure of left ventricular ejection fraction by simple methodology.

Topics: Adult; Cardiac Catheterization; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Female; Heart; Heart Diseases; Humans; Male; Middle Aged; Stroke Volume; Tomography, X-Ray Computed

Interobserver reproducibility of single plane contrast angiographic measurements of end-diastolic volume (EDV/m2), end-systolic volume (ESV/m2), stroke volume (SV/m2), and ejection fraction (EF) was studied in two groups of patients. The first group (n = 42) was an unselected, consecutive series of patients in which the calculations of volume were performed manually, representing day-to-day results from a clinical quantitative angiographic laboratory. The second group (n = 31) was selected on the basis of optimal filming technique and volume calculations were performed digitally with the aid of a computer. This group characterizes the reproducibility that could be attained for investigational purposes. In the selected group, interobserver reproducibility of four regional ejection fractions was determined. The correlation coefficient (r), standard error of the estimate (Sy.x), average difference, and 95% confidence limits are given. Measurement variation accounted for 9-15% of the variance in this study for EDV/m2 (consecutive series), indicating that caution is needed when relating contrast angiographic measurements to other (e.g., noninvasive) measures of volume by simple linear regression.

Topics: Angiocardiography; Cardiac Output; Cineangiography; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Evaluation Studies as Topic; Heart Diseases; Heart Ventricles; Humans; Regression Analysis; Stroke Volume