[Effects on vasomotor tone and hemostatic function of radiologic contrast media used during invasive cardiological procedures].
There are several types of radiologic contrast media which can be used in invasive cardiology: 1) ionic media with high osmolality (2000 mOsm/kg, about 6 times that of plasma), the prototype of which is diatrizoate; 2) ionic media with low osmolality (600-900 mOsm/kg), the prototype of which is ioxaglate; 3) non-ionic monomeric, low-osmolality media, such as iopromide, iopamidol and iohexol; and 4) non-ionic dimeric media, iso-osmolal compared to plasma (290-300 mOsm/kg), among which the most used is iodixanol. Non-ionic media--by far the most expensive--have a generally better tolerability profile for the patient, since they clearly induce a less gastro-intestinal, renal, hemodynamic, electrophysiological and pseudo-allergic side effects. They interfere much less with the physiology of vascular and circulating blood cells, and have lesser negative interference on the hemostatic function. Whether these lesser anti-hemostatic properties become a possible downside in situations at high thrombotic risk, such as in some interventional procedures, has been so far the object of isolated reports, usually with limited numbers of patients, and is presently being verified in adequate clinical trials. Radiologic contrast media also have disparate vasoactive properties on epicardial and myocardial resistance vessels. The knowledge and awareness of such effects is of potential importance for the performance of studies requiring the accurate quantitative evaluation of coronary diameters or of myocardial blood flow.
De Caterina
R
R
Istituto di Fisiologia Clinica, CNR, Pisa.
Limbruno
U
U
D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D003287:Contrast Media / Q000009:adverse effects / Q000494:pharmacology*; D017023:Coronary Angiography / Q000009:adverse effects; D003326:Coronary Circulation / Q000187:drug effects; D003327:Coronary Disease / Q000000981:diagnostic imaging; D003331:Coronary Vessels / Q000187:drug effects*; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006487:Hemostasis / Q000187:drug effects*; D006801:Humans; D066298:In Vitro Techniques; D015641:Radiography, Interventional; D012307:Risk Factors; D014666:Vasomotor System / Q000187:drug effects*
D003287:Contrast Media