Geny B, Mettauer B, Muan B, Bischoff P, Epailly E, Piquard F, Eisenmann B, Haberey P
Laboratoire d'Explorations Fonctionnelles du Système Circulatoire et Service de Chirurgie Cardiovasculaire, Faculté de Médecine, Université Louis Pasteur, Strasbourg, France.
J Am Coll Cardiol. 1993 Oct;22(4):1193-8. doi: 10.1016/0735-1097(93)90437-6.
This study was designed to investigate in patients the effect of a new transpulmonary echo contrast agent, made from 5% human serum albumin (Albunex), on systemic and pulmonary hemodynamics and the influence of the contrast doses on left ventricular opacification.
New intravenous transpulmonary echo contrast agents are promising, allowing contrast stress echocardiography and myocardial contrast echocardiography. Nevertheless, some shortcomings still remain. Thus, the pulmonary hypertension observed in pigs after Albunex injection should be investigated in humans, and the optimal dose of contrast agent remains to be determined because previous experiments indicated that the left ventricular opacification and attenuation are dose dependent.
Albunex in doses of 0.08 and 0.22 ml/kg was successively injected intravenously in 20 catheterized patients; in 11 of them, anti-inflammatory drugs were withdrawn to avoid the blocking of an eventual thromboxane-mediated pulmonary artery hypertension. Systemic blood pressure and pulmonary artery, capillary wedge and right atrial pressures were continuously monitored. Cardiac output, left ventricular fractional shortening and blood gases were determined 5 min before and 5 and 10 min after each injection. The left ventricular opacification was qualitatively assessed by three independent observers using a grading scale from 0 to 3, with 0 indicating an absence of contrast effect and 3 indicating full opacification.
No clinical, hemodynamic or respiratory adverse reactions were observed in any patient. Irrespective of doses, a left ventricular opacification grade > or = 2 was observed in 74% of the 35 injections that could be evaluated. This percentage increased to 94% when the higher dose group was considered alone.
This first report of the effect of Albunex injected intravenously on pulmonary artery pressures in humans demonstrates that this contrast agent appears to be safe. The significant left ventricular opacification obtained in a majority of patients without an important increase in attenuation supports the use of the higher dose of the contrast agent.
本研究旨在调查一种由5%人血清白蛋白制成的新型经肺超声造影剂（Albunex）对患者全身和肺血流动力学的影响，以及造影剂剂量对左心室显影的影响。
新型静脉注射经肺超声造影剂前景广阔，可用于负荷超声心动图和心肌造影超声心动图检查。然而，仍存在一些不足之处。因此，应在人体中研究注射Albunex后猪身上观察到的肺动脉高压情况，并且由于先前的实验表明左心室显影和衰减与剂量有关，造影剂的最佳剂量仍有待确定。
对20例插入导管的患者依次静脉注射0.08和0.22 ml/kg剂量的Albunex；其中11例患者停用抗炎药物，以避免最终由血栓素介导的肺动脉高压受阻。连续监测全身血压、肺动脉、毛细血管楔压和右心房压力。在每次注射前5分钟以及注射后5分钟和10分钟测定心输出量、左心室缩短分数和血气。由三名独立观察者使用0至3级评分量表对左心室显影进行定性评估，0表示无造影剂效果，3表示完全显影。
所有患者均未观察到临床、血流动力学或呼吸方面的不良反应。无论剂量如何，在可评估的35次注射中（74%）观察到左心室显影分级≥2级。单独考虑高剂量组时，这一百分比增至94%。
本关于静脉注射Albunex对人体肺动脉压影响的首次报告表明，这种造影剂似乎是安全的。大多数患者获得了显著的左心室显影，且衰减没有显著增加，这支持使用较高剂量的造影剂。
