Effects of angiographic contrast media on sino-atrial nodal function

White, Carl W.; Eckberg, Dwain L.; Inasaka, Tohru; Abboud, François M.

doi:10.1093/cvr/10.2.214

Cited by 32 publications

(4 citation statements)

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“…These effects as well as adverse electrophysiologic effects7' [20][21][22][23][24] have motivated a search for newer, less toxic contrast media. The prototype nonionic angiographic contrast material is metrizamide, which is essentially devoid of Na+ and has a lower osmolality for equal iodine concentration than do standard contrast agents.…”

Section: Contractile Effects In the Ischemic Statementioning

confidence: 99%

Regional myocardial hemodynamic and metabolic effects of ionic and nonionic contrast media in normal and ischemic states.

Gerber¹,

Higgins²,

Yuh³

et al. 1982

Circulation

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SUMMARY The effects of intracoronary injection of two nonionic contrast media (iohexol and metrizamide) on myocardial contraction and chemical composition of coronary sinus (CS) blood were compared with those caused by the standard ionic contrast material for coronary angiography, sodium meglumine diatrizoate (R76), in 14 anesthetized dogs. The effects of each agent on regional contractility were compared in the normal state and in the presence of a critical coronary artery stenosis.The three contrast media produced equivalent decreases in hematocrit and sodium (both NS), but R76 caused a greater increase in CS osmolality (p < 0.02). R76 caused a significant decrease in CS potassium and ionized calcium (both p < 0.0001), but neither nonionic contrast medium caused a significant change in either potassium or calcium.In the normal state, R76 caused initial transient (< 10 seconds) increases in both end-diastolic (p < 0.006) and end-systolic segment length (p < 0.02) and a decrease in rate of change of segment length (dL/dt) (p < 0.002). The nonionic agents caused a mild increase in dL/dt (p < 0.04) and a decrease in end-systolic segment length (p < 0.03); both returned to control levels within 1 minute. In the presence of a stenosis, R76 caused a more severe and prolonged increase in end-diastolic and end-systolic segment lengths (p < 0.03) and a decrease in dL/dt (p < 0.002), which did not return to control within 2 minutes. The effects of the nonionic agents were similar in both normal and diseased states.We conclude that nonionic contrast media produce fewer alterations than ionic contrast media in coronary sinus blood chemistry and myocardial contractile state. The effect of ionic contrast media on regional contraction is accentuated in the presence of coronary artery stenosis.THE CARDIODEPRESSANT effects of intracoronary administration of iodinated contrast media have long been recognized.1-7 Several studies have implicated single-valence cations as a major factor responsible for the adverse effects on myocardial contractility.", 6-8 An imbalance in the ratio of sodium to calcium ions is also considered to be a factor, and the myocardial depression usually induced by ionic contrast media can be reversed by adding calcium ions.", 9, 10 Another approach to alleviating the myocardial toxicity of contrast media has been to develop contrast media devoid of sodium and other singlevalence cations.Metrizamide, the first nonionic contrast agent, has no sodium and approximately one-third of the osmolality of the standard ionic contrast medium and causes no negative inotropic effects. from the lyophilized form just before use. lohexol is a new nonionic contrast agent that is hydrolytically stable and has a shelf life similar to that of diatrizoate preparations.The purposes of the current study were to compare the myocardial contractile effects of nonionic contrast materials (metrizamide and iohexol) with those of the standard ionic contrast medium, sodium meglumine diatrizoate; to determine the alterations in chemical c...

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Section: Contractile Effects In the Ischemic Statementioning

confidence: 99%

Regional myocardial hemodynamic and metabolic effects of ionic and nonionic contrast media in normal and ischemic states.

Gerber¹,

Higgins²,

Yuh³

et al. 1982

Circulation

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“…The cause of the hyperemic response appears to be related in part to the high osmolality of contrast media since a similar response is seen after injection of hyperosmolar dextrose solution [ 52 , 53 ]. Stimulation of chemoreceptors in the myocardium may contribute to coronary (and peripheral) vasodilation through the Bezold-Jarisch refl ex [ 52 ] and a direct effect on the microcirculation cannot be excluded. The hyperemic response after non-ionic contrast media is less than seen after ionic contrast injection ( Fig.…”

Section: Physiological Effects Of Contrast Materialsmentioning

confidence: 99%

Coronary Angiography

Wilson

2015

Coronary Artery Disease

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“…20 Injection of contrast material into the heart depresses myocardial contractility and changes heart rate and peripheral vascular resistance. '8' 21 These changes usually are not detectable until 3-4 seconds after injection and disappear within 20 minutes. Also, the rate of injection and catheter position may cause premature ventricular complexes that may invalidate segmental measurements.…”

Section: Temporal Relationships Between Ischemiamentioning

confidence: 99%

Quantification of myocardial ischemia and infarction by left ventricular imaging.

Falsetti¹,

Marcus²,

Kerber³

et al. 1981

Circulation

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IN THIS ISSUE of Circulation, two articles deal with quantification of myocardial ischemia by left ventricular imaging techniques: one with the radioisotopic measurement of chord shortening' and the other with echocardiographic measurement of wall motion and thickening.2 Measurements of regional wall motion could quantify the extent of myocardial ischemia and infarction and, if accurately performed, would provide a useful method for assessing the severity of damage from an infarction, determining prognosis and evaluating the effects of interventions designed to limit myocardial necrosis. In this editorial we briefly review limitations of several techniques of quantifying regional wall motion abnormalities.The three most frequently used techniques to measure segmental wall motion are angiography, radionuclide left ventriculography and echocardiography. All three approaches have common problems. Dynamic Cardiac MotionDuring the cardiac cycle, the heart rotates on its long axis and changes its position within the thorax. The geometric center of the left ventricle changes between systole and diastole because the systolic shape of the ventricle is dissimilar to the diastolic shape.3'8 In the normal heart, these geometric factors are small, and are usually neglected. However, in a heart with localized contraction abnormalities, these factors may be very large, with hypercontraction of one segment and hypocontraction of other segments. This increases the distortion or asymmetry of the ventricle.There is also cardiac movement during respiration. This movement can be minimized when data accumulation is completed within two or three cardiac cycles. Contrast ventriculograms or echocardiograms can be recorded during a fixed phase of respiration, but this is not possible with most radionuclide studies.Temporal Relationships between Ischemia and Mechanical Dysfunction With the onset of myocardial ischemia, major mechanical abnormalities occur almost immediately.9

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Effects of angiographic contrast media on sino-atrial nodal function

Cited by 32 publications

References 0 publications

Regional myocardial hemodynamic and metabolic effects of ionic and nonionic contrast media in normal and ischemic states.

Regional myocardial hemodynamic and metabolic effects of ionic and nonionic contrast media in normal and ischemic states.

Coronary Angiography

Quantification of myocardial ischemia and infarction by left ventricular imaging.

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