Coronary arteriography with iotrolan 280, a blood-isotonic, nonionic, dimeric contrast medium: preliminary clinical results.

The effects of coronary arteriography with ionic, monomeric diatrizoate (iodine content, 370 mg/ml; osmolality, 2.10 Osm/kg) and nonionic, dimeric iotrolan (iodine content, 280 mg/ml; osmolality, 0.27 Osm/kg) were intraindividually compared in five patients with coronary heart disease. According to an open protocol, both contrast media were injected into the left (LCA) and right coronary arteries (RCA), 8 ml and 5 ml, respectively. Before, during, and 60 seconds after each injection, electrocardiograms (ECG) were recorded and heart rate and aortic pressure were measured. Whereas diatrizoate markedly decreased heart rate (LCA, -36%; RCA, -20%) and aortic pressure (LCA, -26%; RCA, -16%), iotrolan administration kept heart rate virtually unchanged (+/- 1%) and only slightly increased aortic pressure (LCA, 5%, RCA, 8%). After iotrolan injection ECG changes (axis shift of QRS and T waves) were still demonstrable, yet the effects of diatrizoate proved to be more significant (prolongation of QRS and QT intervals as well as shifts of QRS and T axis). The opacification of the coronary arteries was always more pronounced after diatrizoate due to its higher iodine content, but the contrast produced by iotrolan usually was satisfactory. No side effects were observed during the study. Thus, this isosmotic contrast medium prevents bradycardia and hypotension during coronary arteriography. The lower iodine content, however, leads to poorer contrast compared with conventional contrast media.