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Contrast agent improved patient comfort, reduced change in heart rate

Issue: August 2011

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SCCT 6th Annual Meeting

DENVER — Compared with iopamidol, iodixanol, a lower-iodine-content contrast agent, was found to benefit patient comfort, including rates of chest and arm pain, and decreased the likelihood of patients having an increased heart rate during the study, according to findings presented here.

“Exposure to iodinated contrast is frequently associated with symptoms or side effects which are typically mild and transient. However, these may increase heart rate and or heart rate variability due to anxiety or discomfort,” said Troy LaBounty, MD, study investigator with the Weill Cornell Medical College, New York, in his presentation.

This led LaBounty and fellow researchers from the United States and Canada to conduct a prospective, randomized, pilot phase trial to test whether a lower iodine content iso-osmolar contrast agent, iopamidol (Isovue, Bracco Diagnostics), would improve comfort and heart rate vs. one with higher iodine content, iopamidol (Isovue, Bracco Diagnostics).

The trial involved 67 symptomatic patients who had been referred for elective invasive coronary angiography. Researchers assessed suspected CAD with coronary CTA and randomly assigned patients to either iopamidol (n=29) or iodixanol (n=38). Immediately following coronary CTA, patients completed standardized questionnaires to determine the presence of symptoms.

Overall, there were no significant differences in terms of patient baseline characteristics. However, patients given iodixanol had significantly improved rates of moderate or severe flushing (P=.006), any chest pain (P=.04), any arm pain (P=.04) and any dyspnea or wheezing (P=.04). Heart rate variability, which was defined as the difference between maximum and minimum values, was only slightly improved in the iodixanol group (P=.25), while there was a trend towards improvement in any heart rate increase in the iodixanol arm (P=.06).

Limitations of note, according to LaBounty, included the study being underpowered to detect a difference in the rate of specific and severe symptoms and the lack of assessment of diagnostic accuracy and image quality due to limited sample size. Although, LaBounty did point out that an ongoing parallel randomized controlled trial is currently underway that will address each of these limitations. – by Brian Ellis

Disclosures: Dr. LaBounty reported no relevant financial disclosures.

For more information:

• LaBounty T. Abstract #99. Presented at: The 6th Annual Scientific Meeting of the Society of Cardiovascular Computed Tomography; July 14-17, 2011; Denver.

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