[Coronary arteriography with a plasma-isotonic roentgen contrast medium: effects on ECG, blood pressure and coronary circulation].

The nonionic-dimeric compound lotrolan (0.27 osmol/kg, 280 mg J/ml) is the first contrast medium with plasma-isotonic osmolality and sufficient iodine content for intravascular use. In 15 patients with coronary heart disease, the cardiac side effects of 1) lotrolan, 2) nonionic-monomeric lopromide (0.77 osmol/kg, 370 mg J/ml and 3) ionic-monomeric Amidotrizoate (2.1 osmol/kg, 370 mg J/ml) were compared intraindividually following randomized left coronary artery injections (8 ml). Electrocardiographic indices, aortic pressure, coronary sinus flow (thermodilution method), and coronary vascular resistance were determined before, during, and 60 s after each injection. Heart rate remained almost unchanged with lotrolan (+/- 3%) and lopromide (-8%). Amidotrizoate (-16%), however, caused a significant bradycardia. Aortic pressure decreased markedly after Amidotrizoate (-12%) but only moderately after lopromide (-7%) and lotrolan (-6%). Coronary sinus flow increased to the same extent with lopromide (+66%) and Amidotrizoate (+72%), but less with lotrolan (+43%). Coronary vascular resistance dropped significantly more following lopromide (-38%) and Amidotrizoate (-43%) than after lotrolan (-27%). As opposed to Amidotrizoate and lopromide, lotrolan caused only slight changes in heart rate, blood pressure, and coronary hemodynamics, presumably due to its plasma-isotonic osmolality. Only minor differences were found between the cardiac effects of Amidotrizoate and lopromide. The diagnostic quality of the angiograms, however, was better with Amidotrizoate and lopromide. Thus, due to its reduced cardiac side effects, lotrolan may only be useful in the case of experimental investigations applying digital techniques.