Ricci Maccarini P, Benenati P M, Bellanti G, Piscitelli G
Servizio di Radiologia Ospedaliera, Policlinico S. Orsola, Bologna.
Radiol Med. 1988 Jul-Aug;76(1-2):28-32.
The new techniques for an early treatment of acute myocardial infarction (AMI), such as thrombolysis and percutaneous transluminal angioplasty, often necessitate rapid and accurate radiological evaluation of coronaric lesions and left ventricular function. The aim of the present study was to evaluate both safety and tolerability of selective coronarography (SC) and left ventriculography (LVG), with iopamidol 370 mg I/ml as a contrast medium, in the acute phase of AMI. Thirty-nine patients aged 26-29 years, were examined: 18, group A, within 4 days (mean 2.6 +/- 0.8 SD) and 21, group B, within 5-15 days after AMI (mean 8.8 +/- 3 SD). Contrast media (cm) dosage varied from 150 to 300 ml (2.43-5.5 ml/bw). During the procedure, ECG was continuously recorded; left ventricular pressure was registered immediately before and 30 minutes after cm administration. During the following 9 days ECG tracings and plasmatic cytolysis enzymes were monitored. During the examinations no patient complained of any symptoms. After LVG slight elevations in end diastolic pressure were detected in all patients (mean increase 4.7 mmHg), which were not relevant from a clinical point of view. In 11/39 cases ventricular tachycardia was observed, which spontaneously ceased. During SC no change in ECG tracings was registered except in one patient, group A, in whom complete transitory heart block was detected. After SC no alteration in instrumental and biochemical parameters was registered except in one patient, group B, in whom a reinfarction due to right coronaric artery occlusion was observed. In conclusion, our results suggest that both SC and LVG with iopamidol are safe techniques also in the early phase of myocardial infarction.
急性心肌梗死（AMI）早期治疗的新技术，如溶栓和经皮腔内血管成形术，常常需要对冠状动脉病变和左心室功能进行快速、准确的放射学评估。本研究的目的是评估在AMI急性期使用碘帕醇370mg I/ml作为造影剂进行选择性冠状动脉造影（SC）和左心室造影（LVG）的安全性和耐受性。对39例年龄在26 - 29岁的患者进行了检查：A组18例，在AMI后4天内（平均2.6±0.8标准差）进行检查；B组21例，在AMI后5 - 15天内（平均8.8±3标准差）进行检查。造影剂用量在150至300ml之间（2.43 - 5.5ml/体重）。在操作过程中，持续记录心电图；在注入造影剂前及注入后30分钟记录左心室压力。在接下来的9天内监测心电图描记和血浆细胞溶解酶。检查过程中无患者抱怨任何症状。左心室造影后，所有患者的舒张末期压力均有轻微升高（平均升高4.7mmHg），从临床角度来看无相关性。在39例中有11例观察到室性心动过速，均自行终止。选择性冠状动脉造影过程中，除A组1例患者检测到完全性短暂性心脏传导阻滞外，心电图描记无变化。选择性冠状动脉造影后，除B组1例患者观察到右冠状动脉闭塞导致再梗死外，仪器和生化参数无改变。总之，我们的结果表明，在心肌梗死早期，使用碘帕醇进行选择性冠状动脉造影和左心室造影都是安全的技术。
