Pitton Michael B, Kemmerich Gunter, Herber Sascha, Mayer Eckhard, Thelen Manfred, Düber Christoh
Department of Radiology, University Hospital of Mainz, Langenbeckstr. 1, Mainz, Germany 55131.
AJR Am J Roentgenol. 2006 Jul;187(1):128-34. doi: 10.2214/ajr.04.0833.
The purpose of this study was to investigate the hemodynamic safety of the monomeric nonionic contrast agent iomeprol for selective pulmonary angiography in chronic thromboembolic pulmonary hypertension (CTPH), and to investigate the effect of periinterventional oxygen administration.
Selective pulmonary digital subtraction angiography was performed in 94 patients with CTPH using six bolus injections of iomeprol (posteroanterior, oblique, and lateral projections; both pulmonary arteries; iomeprol, 25 mL at 13 mL/s). Hemodynamics were obtained with Swan-Ganz catheters, and systolic pulmonary artery pressure (PAsyst) was classified into one of three groups: 30 mm Hg or less (control group), greater than 30 but less than or equal to 60 mm Hg (group 1, moderate pulmonary hypertension), and greater than 60 mm Hg (group 2, severe pulmonary hypertension).
At baseline, values for PAsyst were 21.4 +/- 2.3 (control group, n = 8), 49.8+/- 8.5 (group 1, n = 18), and 86.5 +/- 18.9 (group 2, n = 68) mm Hg (p < 0.001). Pulmonary vascular resistance indexes (PVRI) were 222 +/- 105 (control), 703 +/- 364 (group 1), and 1,582 +/- 562 (group 2) dyne x s x cm(-5) x m2 (p < 0.001). The mean cardiac indexes were 3.1 (control), 2.8 (group 1), and 2.3 (group 2) L/min/m2 (p < 0.05). Pulmonary capillary wedge pressure (PCw) indicated healthy left heart function. Periinterventional oxygen inhalation improved oxygen saturation in all groups and slightly reduced pulmonary artery pressure and heart rate. Online measurement of pulmonary artery pressure during contrast bolus injection for angiography showed only a minor increase, predominantly in severe pulmonary hypertension (triangle up [difference] PAsyst: 1.3 +/- 1.9 [control], 2.9 +/- 3.4 [group 1], and 3.8 +/- 4.5 [group 2] mm Hg [p < 0.001]). After completion of angiography, right atrial pressure (RAP) and PAsyst were moderately increased: triangle up RAP: 1.4 (control), 2.6 (group 1, p < 0.001), and 3.0 (group 2, p < 0.001) mm Hg; triangle up PAsyst: 3.2 (control), 7.7 (group 1, p < 0.01), and 8.5 (group 2) mm Hg (p < 0.001). PVRI was significantly higher in group 2 (triangle up PVRI: 188 dyne x s x cm(-5) x m2, p < 0.001).
Selective pulmonary angiography using iomeprol is safe without critical pressure peaks during selective contrast bolus injection or significant hemodynamic derangement in severe CTPH. Periinterventional oxygen inhalation improved pulmonary circulation.
本研究旨在探讨单体非离子型造影剂碘美普尔用于慢性血栓栓塞性肺动脉高压（CTPH）患者选择性肺血管造影的血流动力学安全性，并研究介入治疗期间吸氧的效果。
对94例CTPH患者进行选择性肺数字减影血管造影，分6次团注碘美普尔（前后位、斜位和侧位投照；双侧肺动脉；碘美普尔，25ml，流速13ml/s）。采用Swan-Ganz导管测量血流动力学，收缩期肺动脉压（PAsyst）分为三组之一：30mmHg或更低（对照组），大于30但小于或等于60mmHg（1组，中度肺动脉高压），大于60mmHg（2组，重度肺动脉高压）。
基线时，PAsyst值分别为21.4±2.3（对照组，n = 8）、49.8±8.5（1组，n = 18）和86.5±18.9（2组，n = 68）mmHg（p < 0.001）。肺血管阻力指数（PVRI）分别为222±105（对照组）、703±364（1组）和1582±562（2组）达因·秒·厘米⁻⁵·平方米（p < 0.001）。平均心脏指数分别为3.1（对照组）、2.8（1组）和2.3（2组）L/min/m²（p < 0.05）。肺毛细血管楔压（PCw）表明左心功能正常。介入治疗期间吸氧可提高所有组的血氧饱和度，并轻微降低肺动脉压和心率。血管造影对比剂团注期间在线测量肺动脉压显示仅轻微升高，主要见于重度肺动脉高压（PAsyst升高差值：1.3±1.9（对照组）、2.9±3.4（1组）和3.8±4.5（2组）mmHg（p < 0.001））。血管造影完成后，右心房压（RAP）和PAsyst中度升高：RAP升高：1.4（对照组）、2.6（1组，p < 0.001）和3.0（2组，p < 0.001）mmHg；PAsyst升高：3.2（对照组）、7.7（1组，p < 0.01）和8.5（2组）mmHg（p < 0.001）。2组PVRI显著更高（PVRI升高：188达因·秒·厘米⁻⁵·平方米，p < 0.001）。
使用碘美普尔进行选择性肺血管造影是安全的，在选择性对比剂团注期间无严重压力峰值，在重度CTPH中也无明显血流动力学紊乱。介入治疗期间吸氧可改善肺循环。
