Hemodynamic abnormalities during coronary angiography: Comparison of hypaque-76, hexabrix, and omnipaque-350

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Abstract
The hemodynamic effects induced by coronary angiography in dogs with low osmolar ionic dimer Hexabrix (HB) and nonionic Omnipaque‐350 (OM) were compared to the standard ionic contrast medium, Hypaque‐76 (H76), both in the normal heart and in one with simulated severe cardiac disease. Left coronary angiography was performed in 12 “normal” closed‐chest dogs with 10‐cc injections of H76, HB, and OM in a randomized, blinded fashion. The maximal change in the left ventricular (LV) systolic pressure (SP), mean aortic pressure (MAP), left ventricular end diastolic pressure (LVEDP), and LV dp/dt were recorded. The LVSP and MAP fell 30 ± 3 mm Hg and 26 ± 4 mm Hg with H76, 22 ± 2 mm Hg and 19 ± 2 mm Hg with HB, and 7 ± 1.5 mm Hg and 5 ± 1 mm Hg with OM (P < .001). The LVEDP increased 4.8 ± 0.5 mm Hg with H76, 3 ± 0.5 mm Hg with HB, but only 0.2 mm Hg with OM (P < .001). The LV dp/dt decreased 392 ± 63 mm Hg/sec with H76 and 235 ± 21 mm Hg/sec with HB, but increased 411 ± 50 mm Hg with OM (P < .001). In eight additional open‐chest dogs, left coronary angiography was performed 1 hr after occlusion of the proximal LAD coronary artery and in the presence of a critical circumflex coronary artery (CX) stenosis. Occlusion of the LAD and the creation of a CX stenosis produced a 22 ± 3 mm Hg decrease in LVSP, a 310 ± 64 mm Hg/sec decrease in LV dp/dt, and a 4.7 ± 0.6 mm Hg increase in the LVEDP; 7 cc H76 produced a further 34 ± 6 mm Hg decrease in LVSP, compared with 13 ± 3 mm Hg with HB and 5.3 ± 1.5 mm Hg with OM (P < .001). The LV dp/dt decreased 505 ± 89 mm Hg/sec with H76, 210 ± 64 mm Hg with HB, but increased 265 ± 31 mm Hg with OM (P .001). The LVEDP increased 5.5 ± 1 mm Hg with H76, compared with 2.8 ± 0.6 mm Hg with HB and 0.37 ± 0.26 mm Hg with OM (P < .001). Thus, both low osmolar contrast media caused significantly less myocardial depression than the standard ionic contrast agents. OM is particularly devoid of myocardial depressive effects and produces less hemodynamic alteration than HB.