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European Heart Journal 1987 8(12):1322-1331;
Copyright © 1987 by the European Society of Cardiology.
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© 1987 The European Society of Cardiology

The haemodynamic side-effects of ionic and non-ionic contrast media in the presence of pulmonary hypertension: experimental and clinical investigation

R. SCHRÄDER, G. HELLIGE, M. KALTENBACH and G. KOBER

Department of Cardiology, Centre of Internal Medicine, University of Frankfurt am Main, Medical School, Frankfurt am Main
Department of Experimental Cardiology, Center of Physiology and Pathophysiology, University of Göttingen, Medical School Göttingen, F.R.G.

Received 9 March 1987; revised 19 May 1987; .

Dr. med. R. Schräder, Abterlung für Kardiologue. Zentrum der Inneren Medizin, Klinikum der Universität. Theodor-Stern-Kai 7, D-6000 Frankfurt am Main, F R G.

The haemodynamic side-effects of ionic (amidotrizoate) and non-ionic (iopamidol) constrast media after injection into the right atrium were compared in experimental and clinical studies.Pulmonary hypertension was induced in 10 dogs by embolization of the pulmonary vascular bed with agaragar solution (mean pulmonary artery pressure=44.2 mm Hg). Iopamidol (1.5ml kg-1) caused a moderate decrease in pulmonary and systemic vascular resistance, slight increases in right ventricular end-diastolic pressure and a marked rise in right ventricular contractility (dP/dtmax). Amidotrizoate (1.5ml kg-1) caused considerable systemic vasodilation and initial increase in pulmonary vascular resistance and pressure followed by a substantial increase in right ventricular end-diastolic pressure and a decrease in contractility.Central and peripheral haemodynamics were measured in 20 patients with pulmonary hypertension (mean pulmonary artery pressure=38.1 mm Hg) due to valvular heart disease before and following injections with 40 ml of both types of constrast medium in randomized order. Heart rate, cardiac output and right atrial pressure rose significantly more after amidotrizoate and this constrast medium caused more extensive systemic vasodilation and a larger decrease in aortic pressure as compared to iopamidol. Pulmonary artery pressure went up moderately with both contrast media.It is concluded that non-ionic low-osmolality constrast media like iopamidol induce less pronounced haemo-dynamic alterations, in particular less increase in right ventricular filling pressure. This may be beneficial to patients with pulmonary hypertension undergoing angiocardiography or digital subtraction angiography.

Key Words: Contrast media • haemodynamic side-effects • effect of drugs on heart • angiocardiography • digital subtraction angiography • pulmonary hypertension


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