Itaru Motegi

Changes in hemodynamics due to the contrast medium during left ventriculography.

Seventeen patients with heart diseases examined by left ventricular angiography were divided into two groups consisting of those with a clinical history of heart failure (CHF+) and those without (CHF-). Changes in hemodynamics, circulating blood volume, and plasma volume due to injection of the contrast medium were studied, and the following results were obtained. Both the CHF - and CHF + groups showed an increase in heart rate after injection of the contrast medium, but a statistically significant difference (p < 0.05) was noted only at one and two minutes after angiography in both groups. Left ventricular systolic pressure decreased after injection of the contrast medium in both groups, but the CHF+ group required a longer time for recovery. In the CHF - group, the left ventricular end-diastolic pressure increased slightly after injection of the contrast medium, but in the CHF+ group it increased markedly with a statistically significant difference (p < 0.01). Stroke volume, measured by a noninvasive, continuous cardiac output monitor according to the impedance method, increased upon injection of the contrast medium in the CHF— group. However, in the CHF+ group it decreased, although no statistically significant difference was noted in either group. Cardiac index increased markedly upon injection of the contrast medium in the CHF— group with a statistically significant difference (p < 0.01), but hardly any change was observed in the CHF+ group. Circulating blood volume increased in both groups ten minutes after injection of the contrast medium, but whereas the CHF - group showed no statistically significant increase and had a gradual reduction to the original state an hour afterward, a statistically significant increase over original values in the CHF+ group was observed at ten minutes and one hour after injection. The mean value of the CHF+ group was statistically significantly higher than that of the CHF- group at one hour after injection. Circulating plasma volume showed statistically significant mean increases over original values in both groups at ten minutes and at one hour after injection of the contrast medium. The mean value of the CHF+ group was statistically significantly higher than that of the CHF- group at one hour after injection. In conclusion, patients with heart failure, in comparison with those without, showed different changes in hemodynamics, circulating blood, and plasma volumes caused by the contrast medium, and thus it was necessary to be cautious when the contrast medium was injected into patients with a history of heart failure.