Effects of non-ionic iodinated contrast media on patient heart rate and pressures during intra-cardiac or intra-arterial injection

Abstract

Purpose To compare the effects on heart rate (HR), on left ventricular (LV) or arterial pressures, and the general safety of a non-ionic low-osmolar contrast medium (CM) and a non-ionic iso-osmolar CM in patients undergoing cardiac angiography (CA) or peripheral intra-arterial digital subtraction angiography (IA-DSA). Materials and methods Two double-blind, randomized studies were conducted in 216 patients who underwent CA ( n = 120) or peripheral IA-DSA ( n = 96). Patients referred for CA received a low-osmolar monomeric CM (iomeprol-350, n = 60) or an iso-osmolar dimeric CM (iodixanol-320; n = 60). HR and LV peak systolic and end-diastolic pressures were determined before and after the first injection during left and right coronary arteriography and left ventriculography. Monitoring for all types of adverse event (AE) was performed for 24 h following the procedure. t-tests were performed to compare CM for effects on HR. Patients referred for IA-DSA received iomeprol-300 ( n = 49) or iodixanol-320 ( n = 47). HR and arterial blood pressure (BP) were evaluated before and after the first 4 injections. Monitoring for AE was performed for 4 h following the procedure. Repeated-measures ANOVA was used to compare mean HR changes across the first 4 injections, whereas changes after the first injection were compared using t-tests. Results No significant differences were noted between iomeprol and iodixanol in terms of mean changes in HR during left coronary arteriography ( p = 0.8), right coronary arteriography ( p = 0.9), and left ventriculography ( p = 0.8). In patients undergoing IA-DSA, no differences between CM were noted for effects on mean HR after the first injection ( p = 0.6) or across the first 4 injections ( p = 0.2). No significant differences ( p > 0.05) were noted in terms of effects on arterial BP in either study or on LV pressures in patients undergoing CA. Non-serious AE considered possibly CM-related (primarily headache and events affecting the cardiovascular and digestive systems) were reported more frequently by patients undergoing CA and more frequently after iodixanol (14/60 [23.3%] and 2/47 [4.3%]; CA and IA-DSA, respectively) than iomeprol (10/60 [16.7%] and 1/49 [2%], respectively). Conclusions Iomeprol and iodixanol are safe and have equally negligible effects on HR and LV pressures or arterial BP during and after selective intra-cardiac injection and peripheral IA-DSA. Clinical application Iomeprol and iodixanol are safe and equally well tolerated with regard to cardiac rhythm and clinical preference should be based on diagnostic image quality alone.