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A comparison of iohexol and diatrizoate-meglumine in children undergoing cardiac catheterization
A N Pelech1, S M Allard, R T Hurd
1Variety Children's Heart Centre, University of Manitoba, Winnipeg, Canada.
Insights
Iohexol, a nonionic contrast agent, causes fewer hemodynamic changes than diatrizoate-meglumine in children undergoing cardiovascular evaluations. This makes iohexol a preferred choice for pediatric patients due to its enhanced safety profile.
Area of Science:
- Pediatric Cardiology
- Radiology
- Pharmacology
Background:
- Cardiovascular evaluations in children often require contrast agents.
- Hemodynamic stability is crucial during pediatric cardiac procedures.
- Assessing the safety and efficacy of different contrast media is vital.
Purpose of the Study:
- To compare the efficacy, safety, and hemodynamic effects of iohexol and diatrizoate-meglumine in pediatric patients.
- To determine which contrast agent is better suited for routine or emergency cardiovascular evaluations in children.
- To evaluate the impact of contrast media on hemodynamic parameters and image quality.
Main Methods:
- A double-blind, randomized study involving 44 children.
- Random allocation to receive either iohexol or diatrizoate-meglumine.
- Systemic ventricular injection and monitoring of hemodynamic parameters (blood pressure, heart rate, dP/dt, QT interval).
Main Results:
- Iohexol demonstrated significantly less hemodynamic alteration compared to diatrizoate-meglumine.
- Lower impact on systemic systolic blood pressure, end-diastolic pressure, and dP/dt with iohexol.
- Iohexol also showed less alteration in heart rate and QT interval; image quality was comparable, with less patient mobility.
Conclusions:
- Iohexol, a nonionic contrast medium, induces less hemodynamic disturbance in children than diatrizoate-meglumine.
- Iohexol is a safer and preferred contrast agent for pediatric cardiovascular evaluations, especially in high-risk patients.
- The findings support the use of iohexol to minimize adverse hemodynamic effects in pediatric contrast angiography.
Abstract:
Iohexol (Omnipaque) and meglumine and sodium diatrizoate (Renografin-76) were compared in a double-blind, randomized study for their efficacy, safety, and hemodynamic effects as angiographic contrast agents in children. Forty-four children were randomly allocated to receive either iohexol or diatrizoate as a component of their routine or emergency cardiovascular evaluation. Following age stratification, baseline physiologic parameters were not significantly different between patients receiving either iohexol or diatrizoate. After systemic ventricular injection, iohexol produced significantly less hemodynamic alteration in systemic systolic blood pressure, systemic ventricular end-diastolic pressure, and dP/dt. Less alteration in heart rate and significantly less effect on the QT interval were seen with iohexol. Image quality was comparable, although significantly more patient mobility was associated with diatrizoate-meglumine. This study shows that iohexol, a nonionic contrast medium, causes less hemodynamic disturbance than diatrizoate-meglumine in children. Therefore, its use to be preferred in these potentially high-risk patients.