Piao Z E, Murdock D K, Hwang M H, Raymond R M, Scanlon P J
Loyola University Medical Center, Maywood, Illinois.
Cathet Cardiovasc Diagn. 1988;14(1):53-8. doi: 10.1002/ccd.1810140113.
Coronary angiography with standard ionic contrast media is associated with marked alterations in cardiac hemodynamics because of the depressant effects of the contrast media on cardiac contractility. Nonionic contrast media have been reported to produce less hemodynamic alteration than standard ionic contrast media. However, there is no information on how one nonionic media compares to another. Thus we compared the hemodynamic effects of three nonionic contrast media, Iopamidol (IOP), Iohexol (IOH), and Ioversol (IOV) to each other as well as to the standard ionic contrast media Hypaque-76 (H76). In 20 closed-chest anesthetized dogs, we recorded the maximal change in left ventricular systolic pressure (LVSP), mean aortic pressure, left ventricular diastolic pressure (LVDP), and left ventricular dp/dt during 10-cc left main coronary artery injections of H76, IOP, IOH, and IOV. The mean aortic pressure and LVSP decreased 36 +/- 17 mm Hg and 46 +/- 21 mm Hg with H76 but only 5 +/- 5 mm Hg and 6 +/- 5 mm Hg with IOP, 5 +/- 4 mm Hg and 6 +/- 6 mm Hg with IOH, and 5 +/- 4 mm Hg and 7 +/- 6 mm Hg with IOV (P less than 0.001). The LVDP increased 6 +/- 5.0 mm Hg with H76 but only 0.2 +/- 0.5 mm Hg with IOP, 0.2 +/- 0.3 mm Hg with IOH, and 0.5 +/- 1.0 mm Hg with IOV (P less than 0.001). The LV dp/dt decreased 545 +/- 261 mm Hg/sec with H76 but increased 886 +/- 477 mm Hg/sec with IOP, 910 +/- 96 mm Hg/sec with IOH, and 473 +/- 335 mm Hg/sec with IOV (P less than 0.001). Whereas each nonionic agent produced significantly less hemodynamic abnormalities than H76, there was no significant difference between any of the nonionic agents on any hemodynamic parameter. Thus, as compared to H76, these nonionic contrast media produced only trivial alterations in hemodynamics and LV dp/dt. These agents may be preferable in patients with LV dysfunction.
使用标准离子型造影剂进行冠状动脉造影时，由于造影剂对心肌收缩力的抑制作用，会导致心脏血流动力学发生显著改变。据报道，非离子型造影剂引起的血流动力学改变比标准离子型造影剂少。然而，关于一种非离子型造影剂与另一种非离子型造影剂相比情况如何，尚无相关信息。因此，我们比较了三种非离子型造影剂碘帕醇（IOP）、碘海醇（IOH）和碘佛醇（IOV）彼此之间以及与标准离子型造影剂泛影葡胺 -76（H76）的血流动力学效应。在20只开胸麻醉的犬中，我们记录了在向左主冠状动脉注射10毫升H76、IOP、IOH和IOV期间左心室收缩压（LVSP）、平均主动脉压、左心室舒张压（LVDP）和左心室dp/dt的最大变化。注射H76时，平均主动脉压和LVSP分别下降36±17毫米汞柱和46±21毫米汞柱，而注射IOP时分别下降5±5毫米汞柱和6±5毫米汞柱，注射IOH时分别下降5±4毫米汞柱和6±6毫米汞柱，注射IOV时分别下降5±4毫米汞柱和7±6毫米汞柱（P<0.001）。注射H76时LVDP升高6±5.0毫米汞柱，而注射IOP时仅升高0.2±0.5毫米汞柱，注射IOH时升高0.2±0.3毫米汞柱，注射IOV时升高0.5±1.0毫米汞柱（P<0.001）。注射H76时LV dp/dt下降545±261毫米汞柱/秒，而注射IOP时升高886±477毫米汞柱/秒，注射IOH时升高910±96毫米汞柱/秒，注射IOV时升高473±335毫米汞柱/秒（P<0.001）。虽然每种非离子型造影剂产生的血流动力学异常均明显少于H76，但在任何血流动力学参数上，任何一种非离子型造影剂之间均无显著差异。因此，与H76相比，这些非离子型造影剂仅引起血流动力学和LV dp/dt的轻微改变。这些造影剂可能更适合左心室功能不全的患者。
