Immediate hemodynamic effects of cardiac angiography in man

Abstract

Changes in human circulatory physiology occurring in the minutes after intracardiac injection of angiographic contrast material have been well documented, but little information is available for the period of left ventricular opacification. The immediate and instantaneous effect on left ventricular function of the rapid intracardiac injection of 1 ml/kg body weight of 75 percent sodium-meglumine diatrizoate (Hypaque M®) into the pulmonary artery, left atrium or left ventricle in 43 adult patients was studied by measurement during angiography of (1) peak aortic root blood velocity in 28 patients, (2) instantaneous stroke volume (computed from the velocity tracing) in 28 patients, (3) heart rate in 41 patients, (4) left ventricular end-diastolic pressure in 17 patients, and (5) left ventricular end-diastolic and end-systolic volumes (calculated from the single-plane cineangiogram) in 14 patients. During left ventricular opacification, variables 1 through 4 differed only slightly from control values; the only statistically significant changes were in peak velocity after pulmonary arterial injection (114 percent of control, control = 100 percent), heart rate after left atrial injection (93 percent of control) and left ventricular end-diastolic pressure after left ventricular injection (110 percent of control). Sequential left ventricular end-diastolic and end-systolic volumes measured over 3 to 5 cardiac cycles demonstrated no significant change. We conclude that measurements based on angiographic left ventricular volumes should be valid and correspond closely to the control state. The major hemodynamic changes secondary to contrast injection occur later, beginning 15 to 30 seconds after injection.