Pulmonary hypertension. Response of vasoactive peptides to a nonionic contrast medium in patients undergoing pulmonary angiography.
OBJECTIVE
The degree to which pulmonary angiography may contribute to serious complications in patients with pulmonary hypertension has not been clarified and remains a matter of debate. Accordingly, this study was designed (1) to detect the potential release of vasoactive peptides and (2) to investigate the hemodynamic response after administration of a nonionic contrast medium in patients with pulmonary hypertension undergoing pulmonary angiography. Allergy-mediating substances also were measured to monitor for possible anaphylactoid reactions.


METHODS
Pulmonary digital subtraction angiography was performed in 20 patients with pulmonary hypertension (mean pulmonary arterial pressure more than 20 mm Hg). Iopromide was administered as a total of 100 mL via a 7F catheter inserted from the right femoral vein. The injected volume and duration of injection (15 to 20 mL/sec) were kept constant. Hemodynamic parameters were continuously monitored, including electrocardiogram, heart rate, phasic and mean pulmonary arterial and peripheral arterial pressures. Blood samples were obtained before and after administration of contrast media to assay for the concentration of the following vasoactive peptides using radioimmunoassay techniques: renin, angiotensin-I-converting enzyme, angiotensin II, aldosterone, atrial natriuretic peptide, antidiuretic hormone, cyclic-guanosine monophosphate, and myoglobin, as well as allergy-mediating substances such as tryptase, eosinophil protein X, and eosinophil cationic protein.


RESULTS
Administration of iopromide caused significant increases in atrial natriuretic peptide (from 61.3 +/- 11.8 to 94.0 +/- 16.7) and antidiuretic hormone (from 6.6 +/- 1.9 to 12.3 +/- 3.1), whereas renin significantly decreased (from 3.0 +/- 0.6 to 1.3 +/- 0.5). After administration of contrast media, there were no significant changes in the other measured vasoactive peptides, allergy-mediating substances, and monitored cardiovascular parameters.


CONCLUSIONS
Administration of iopromide for pulmonary angiography in patients with pulmonary hypertension resulted in no appreciable hemodynamic alterations associated with the observed changes in atrial natriuretic peptide, antidiuretic hormone, and renin. No allergy-mediated reactions were observed in these patients.
Department of Radiology, University of California, San Francisco 94143-0628, USA.
D H
DH
Szolar
M
M
Saeed
F
F
Flueckiger
K
K
Preidler
M A
MA
Stiskal
N
N
Watzinger
T
T
Riepl
J
J
Horina
D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D000707:Anaphylaxis / Q000097:blood / Q000139:chemically induced / Q000503:physiopathology; D015901:Angiography, Digital Subtraction / Q000009:adverse effects; D000804:Angiotensin II / Q000097:blood / Q000187:drug effects; D009320:Atrial Natriuretic Factor / Q000097:blood / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D001798:Blood Proteins / Q000032:analysis / Q000187:drug effects; D053818:Chymases; D003287:Contrast Media / Q000008:administration & dosage / Q000494:pharmacology*; D006152:Cyclic GMP / Q000097:blood; D004562:Electrocardiography / Q000187:drug effects; D047091:Eosinophil Granule Proteins; D047208:Eosinophil-Derived Neurotoxin; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood* / Q000503:physiopathology; D018836:Inflammation Mediators / Q000097:blood; D007472:Iohexol / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009211:Myoglobin / Q000097:blood / Q000187:drug effects; D010455:Peptides / Q000187:drug effects / Q000378:metabolism*; D007703:Peptidyl-Dipeptidase A / Q000097:blood / Q000187:drug effects; D012083:Renin / Q000097:blood / Q000187:drug effects; D012260:Ribonucleases; D012697:Serine Endopeptidases / Q000097:blood / Q000187:drug effects; D053802:Tryptases; D014667:Vasopressins / Q000097:blood / Q000187:drug effects
D001798:Blood Proteins; D003287:Contrast Media; D047091:Eosinophil Granule Proteins; D018836:Inflammation Mediators; D009211:Myoglobin; D010455:Peptides; D014667:Vasopressins; D000804:Angiotensin II; D007472:Iohexol; D000450:Aldosterone; C038192:iopromide; D009320:Atrial Natriuretic Factor; D047208:Eosinophil-Derived Neurotoxin; D012260:Ribonucleases; D007703:Peptidyl-Dipeptidase A; D012697:Serine Endopeptidases; C083294:chymase 2; D053818:Chymases; D053802:Tryptases; D012083:Renin; D006152:Cyclic GMP