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Effects of angiographic contrast medium on left ventricular function: evaluation by contrast angiography and
Insights
Angiographic contrast media can temporarily reduce left ventricular (LV) function, measured by ejection fraction (EF), for up to an hour after cardiac catheterization. This effect is more common in patients with normal resting LV function and may be masked by nitroglycerin use.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Left ventricular (LV) function is crucial for cardiac health.
- Diagnostic cardiac catheterization often involves contrast media administration.
Purpose of the Study:
- To assess the impact of angiographic contrast medium on LV function.
- To evaluate changes in ejection fraction (EF) post-cardiac catheterization.
Main Methods:
- Utilized contrast ventriculography and radionuclide angiograms.
- Performed beat-by-beat analysis of EF during and after catheterization.
- Compared EF before and after the procedure in 26 patients.
Main Results:
- Ejection fraction (EF) was significantly lower after contrast ventriculography (P < .01).
- A decrease in EF (≥5%) occurred in 42% of patients, persisting up to 65 minutes.
- Reduced EF was more frequent in patients with normal resting LV function (P < .05).
- Nitroglycerin administration was associated with a lower incidence of EF decrease.
Conclusions:
- Angiographic contrast media can acutely depress LV function.
- The depressant effect on EF may last up to 1 hour post-procedure.
- Patients with normal baseline LV function are more susceptible to contrast-induced EF reduction.
- Nitroglycerin may mitigate the observed decrease in LV function.
Abstract:
The purpose of this study was to evaluate the effect of angiographic contrast medium on left ventricular (LV) function in 26 patients undergoing diagnostic cardiac catheterization. Beat-by-beat analysis during contrast ventriculography showed that the ejection fraction (EF) was lower in the last beats than in the first beats (P less than .02). Radionuclide angiograms were obtained the day before, as well as 15 to 65 minutes after catheterization, which included contrast ventriculography and coronary anteriography. The EF by radionuclide angiography was lower after catheterization than before (43 +/- 14% vs 47 +/- 17%, P less than .01). The EF decreased by greater than or equal to 5% in 11 of the 26 patients (42%) after catheterization. The decrease in EF in some patients was observed up to 65 minutes after catheterization and was not associated with symptoms or ST-T changes. The EF decreased in only one of nine patients who received nitroglycerin during catheterization, whereas it decreased in 10 of 17 patients who did not receive nitroglycerin (P less than .05). The EF decreased in 9 of 14 patients (64%) who had normal resting LV function, whereas it decreased in only 2 of 12 patients (17%) who had abnormal resting function (P less than .05). Thus, contrast material may depress LV function up to 1 hr and is more frequent in patients with normal resting EF. The use of nitroglycerin during catheterization may mask this effect.