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Effects of contrast media on the RR and QT interval during coronary arteriography
M Mitsumori1, K Hayakawa, T Soga
1Department of Radiology, Kyoto City Hospital, Japan.
Insights
Coronary arteriography contrast media can prolong RR and QT intervals. Low-osmolality media like iohexol and ioxaglate show fewer cardiac effects than older agents, suggesting chemotoxicity is also a factor.
Area of Science:
- Cardiology
- Radiology
- Pharmacology
Background:
- Coronary arteriography can transiently prolong RR and QT intervals.
- Animal studies suggest low-osmolality contrast media have less cardiac impact.
- Clinical data on contrast media effects on cardiac conduction are limited.
Purpose of the Study:
- To clinically assess the impact of different contrast media on RR and QT intervals during coronary arteriography.
- To compare the electrocardiographic effects of various iodinated contrast agents.
- To identify factors influencing contrast media-induced cardiac conduction changes.
Main Methods:
- Analysis of 95 electrocardiographic records from patients undergoing coronary arteriography.
- Assessment of maximal RR and QT interval prolongation.
- Comparison of effects from meglumine sodium diatrizoate, iopamidol, iohexol, and meglumine sodium ioxaglate.
Main Results:
- Meglumine sodium diatrizoate caused the most significant electrocardiographic changes.
- Among low-osmolality media, meglumine sodium ioxaglate had the least bradycardial effect.
- Iohexol demonstrated the smallest QT interval prolongation.
Conclusions:
- Contrast media choice impacts cardiac conduction during coronary arteriography.
- Low-osmolality contrast media generally have less adverse effect on cardiac intervals.
- Factors beyond osmolality, including chemotoxicity, are crucial for assessing cardiac safety.
Abstract:
During coronary arteriography, transient prolongation of the RR and QT intervals can be observed to occur. Animal experiments have suggested that low-osmolality contrast media have less effect, but there have been few clinical studies of this phenomenon. We analyzed 95 electrocardiographic records from patients who had undergone coronary arteriography and assessed the maximal prolongation of the RR and QT intervals. The contrast media used for arteriography included meglumine sodium diatrizoate, iopamidol, iohexol, and meglumine sodium ioxaglate. Diatrizoate caused the greatest electrocardiographic changes. Among the low osmolality contrast media, ioxaglate caused the smallest bradycardial effect and iohexol the smallest prolongation of the QT interval. It appears necessary to consider some additional factors for osmolality or ionicity, such as the chemotoxicity of the chemical structure of the iodinated contrast medium moiety, when assessing their potential adverse effect on the cardiac conduction system.