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Hemodynamic changes after angiocardiography with a new low osmolar contrast medium (sodium-meglumin-joxaglat)
Insights
Sodium-meglumin-joxaglat (Hexabrix) showed a significant advance in angiocardiography compared to sodium-meglumin-diatrizoat (Urografin 76), with less patient discomfort and comparable hemodynamic effects.
Area of Science:
- Cardiology
- Radiology
- Pharmacology
Background:
- Left ventriculography is a key diagnostic procedure in cardiology.
- Contrast media used in angiography can induce hemodynamic changes and patient discomfort.
- Comparing the safety and efficacy of different contrast agents is crucial for optimizing patient care.
Purpose of the Study:
- To compare the hemodynamic effects of sodium-meglumin-joxaglat (Hexabrix) and sodium-meglumin-diatrizoat (Urografin 76) during left ventriculography.
- To assess patient-reported discomfort associated with each contrast agent.
- To evaluate the impact of these agents on left ventricular function and volumes.
Main Methods:
- A double-blind, randomized study involving 24 patients undergoing left ventriculography.
- Hemodynamic parameters (pressures, cardiac index, stroke volume index, left ventricular work index) were measured at rest and post-injection.
- Left ventricular volumes and ejection fraction were calculated.
- Patient discomfort was graded on a 1-4 scale.
Main Results:
- Both contrast agents caused comparable increases in right atrial, pulmonary artery, and pulmonary capillary wedge pressures.
- Urografin 76 led to significantly higher increases in cardiac index and stroke volume index, and a significant increase in left ventricular work index.
- Ejection fraction decreased slightly in both groups (11% for Hexabrix, 9% for Urografin).
- Patients reported significantly less discomfort with Hexabrix (1.83) compared to Urografin (2.83).
Conclusions:
- Sodium-meglumin-joxaglat (Hexabrix) offers an advantage in angiocardiography due to reduced patient discomfort.
- Hemodynamic effects were largely comparable, though Urografin 76 showed some differences in cardiac output parameters.
- Hexabrix represents an improvement in both subjective and objective aspects of left ventriculography.
Abstract:
We evaluated the hemodynamic effects of sodium-meglumin-joxaglat (Hexabrix) compared to sodium-meglumin-diatrizoat (Urografin 76) after left ventriculography in a double-blind randomized study on 24 patients (12 patients per group). Hemodynamic measurements at rest and the extent of ischemic heart disease were comparable in the two groups. Measurements were made at rest and between the second and third minute, between the fifth and sixth minute, and between the eighth and ninth minute following injection of 0.7 ml/kg of contrast medium into the left ventricle. Additionally left ventricular volumes and ejection fraction of the second and fifth beat following the onset of injection were calculated. The discomfort was graded by the patients on a scale of 1-4. After 3 min there was a significant but comparable increase in right atrial, pulmonary artery, and pulmonary capillary wedge pressure (64, 35, and 61%, respectively for the Hexabrix group and 61, 36, and 58% for the Urografin group). Cardiac index and stroke volume index rose significantly higher in the Urografin group and left ventricular work index increased significantly only after injection of Urografin 76. Ejection fraction decreased 11% in the Hexabrix group and 9% in the Urografin group. The grade of discomfort was 1.83 +/- 1 in Hexabrix group and 2.83 +/- 0.8 in the Urografin group (p less than 0.05). Thus, Hexabrix represents an advance in angiocardiography, both from the subjective and objective standpoint.