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Effect of calcium-binding additives on ventricular fibrillation and repolarization changes during coronary
L S Zukerman1, T D Friehling, N M Wolf
1Department of Medicine, Medical College of Pennsylvania, Philadelphia 19129.
Insights
Renografin-76, used in coronary angiography, was linked to ventricular fibrillation due to its calcium-binding additives. A newer contrast agent, Angiovist-370, significantly reduced this risk, indicating improved safety in cardiac procedures.
Area of Science:
- Cardiology
- Radiology
- Pharmacology
Background:
- Ventricular fibrillation during coronary angiography has been associated with Renografin-76, a meglumine sodium diatrizoate contrast agent.
- The calcium-binding additives, sodium citrate and ethylenediaminetetraacetic acid (EDTA), in Renografin-76 are suspected to cause repolarization changes, including QT interval prolongation.
Purpose of the Study:
- To compare the incidence of ventricular fibrillation and QT interval changes between Renografin-76 and Angiovist-370 during coronary angiography.
- To evaluate the safety profile of Angiovist-370, a newer contrast agent with a decreased calcium-binding effect due to calcium EDTA.
Main Methods:
- A prospective randomized trial involving 816 patients undergoing coronary angiography.
- Patients were assigned to receive either Renografin-76 or Angiovist-370.
- Ventricular fibrillation incidence and QT intervals (corrected QT or QTc) were measured and analyzed.
Main Results:
- Ventricular fibrillation occurred in 10 of 410 patients receiving Renografin-76, but in 0 of 406 patients receiving Angiovist-370 (p < 0.0005).
- The mean QTc interval was significantly prolonged 10 seconds after coronary artery injections in patients receiving Renografin-76 compared to Angiovist-370 (p < 0.00005).
- QT interval prolongation differentiated patients receiving Renografin-76 from those receiving Angiovist-370.
Conclusions:
- Angiovist-370 is associated with a significantly lower incidence of ventricular fibrillation compared to Renografin-76 during coronary angiography.
- The reduced calcium-binding effect of Angiovist-370 may contribute to its improved safety profile by minimizing QT interval prolongation.
Abstract:
Ventricular fibrillation during coronary angiography with Renografin-76 (meglumine sodium diatrizoate) has been attributed to the calcium-binding additives sodium citrate and sodium ethylenediaminetetraacetic acid (EDTA), which may produce repolarization changes manifested as prolongation of the QT interval. Angiovist-370 is a newer form of meglumine sodium diatrizoate that contains calcium EDTA as its additive and thus has a decreased calcium-binding effect. Eight hundred sixteen patients were prospectively randomized to receive either Renografin-76 or Angiovist-370. Ventricular fibrillation occurred in 10 of 410 patients receiving Renografin-76 and in 0 of 406 patients given Angiovist-370 (p less than 0.0005). Clinical data were analyzed without knowledge of other data in the 10 patients treated with Renografin-76 who had ventricular fibrillation (Group I), 103 randomly selected patients who also received Renografin-76 but had no ventricular fibrillation (Group II) and 108 randomly selected patients given Angiovist-370 (Group III). Of several variables examined, only the QT interval differentiated patients receiving Renografin-76 and Angiovist-370. The mean corrected QT interval (QTc interval) before coronary angiography was slightly but not significantly (p = 0.7) higher in Group I than in Groups II and III. Ten seconds after the first left coronary artery injection it was more prolonged in Groups I and II (0.552 and 0.561 second, respectively) than in Group III (0.448 second) (p less than 0.00005). Similarly, 10 seconds after the first right coronary artery injection it was significantly longer in Groups I and II (0.545 and 0.544 second) than in Group III (0.477 second) (p less than 0.00005).(ABSTRACT TRUNCATED AT 250 WORDS)