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Budoff MJ, Lee HS, Roy SK, Shekar C. Efficacy and Safety of Iodixanol in Computed Coronary Tomographic Angiography and Cardiac Catheterization. J Cardiovasc Dev Dis 2023; 10:449. [PMID: 37998507 PMCID: PMC10671983 DOI: 10.3390/jcdd10110449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
Iodixanol is an iso-osmolar non-ionic dimeric hydrophilic contrast agent with a higher viscosity than the monomeric agents. It is the only Food and Drug Administration (FDA)-approved iso-osmolar agent in the United States, and it is the only contrast agent with an FDA-approved indication for use in cardiac computed tomographic angiography (CCTA), to assist in the diagnostic evaluation of patients with suspected coronary artery disease. In clinical studies, it has been noted to have fewer side effects and similar image quality when compared to low-osmolar contrast media. This can be attributed to the pharmacological properties of iodixanol. These contrast agents are used for coronary computed tomography angiography and cardiac catheterization. In this article, the use, tolerability, and efficacy of iodixanol are reviewed, specifically evaluating the use of CCTA and coronary angiography, including outcome studies, randomized trials, and comparisons to other contrast agents.
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Affiliation(s)
- Matthew J. Budoff
- Department of Cardiology, Lundquist Institute, Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA;
| | | | - Sion K. Roy
- Department of Cardiology, Lundquist Institute, Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA;
| | - Chandana Shekar
- Department of Cardiology, College of Medicine, Banner-University of Arizona, 1111 E McDowell Road, Phoenix, AZ 85006, USA;
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Hemodynamic effects of intravenous bolus injection of iopromide 370 twice in abdominal contrast-enhanced CT and coronary CTA dual-site sequential examinations. Med Biol Eng Comput 2023; 61:179-194. [PMID: 36342597 DOI: 10.1007/s11517-022-02705-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 10/22/2022] [Indexed: 11/09/2022]
Abstract
Little information is available about how intravenous bolus injection of iopromide 370 twice in a short time will affect hemodynamics and whether the changes reach clinically relevant levels. In the present study, 31 healthy adult volunteers received abdominal contrast-enhanced CT and coronary CTA sequential examinations. The same dose and rate of normal saline was injected 30 min in advance as self-control. Hemodynamic data were noninvasively collected at selected time points from 1 min prior to injection to 30 min post-injection. The results showed that after iopromide 370 injection, except for stroke volume, all other indicators changed immediately during the first injection, changed most significantly during the second injection (P < 0.05), and returned to baseline within 10 min. Heart rate and cardiac output exhibited the most pronounced changes, with an increasing rate of 33.5% and 33.8%, respectively. For indicators with a change range of > 15% during the second injection, except for mean arterial pressure and total peripheral resistance, the proportions of subjects for the other indicators between the two groups were statistically different (P < 0.05). In conclusion, intravenous bolus injection of iopromide 370 twice in dual-site sequential examinations induced dose-cumulative and time-dependent hemodynamic effects, which all fluctuated within the normal ranges.
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Alhelaly MM, Abdelhakim AM, Ellotf H, Khaled A, Soliman AM, Attia MM. Comparative effect of iso-osmolar versus low-osmolar contrast media on vascular attenuation, image quality, and heart rate changes in coronary CT angiography: A systematic review and meta-analysis. Clin Imaging 2020; 61:69-79. [PMID: 31982704 DOI: 10.1016/j.clinimag.2020.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Comparison of iso-osmolar contrast media (IOCM) and low-osmolar contrast media (LOCM) for vascular attenuation, image quality, heart rate changes, and common patient discomfort symptoms. METHODS We searched PubMed, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL). We included only randomized controlled trials. Screening, data extraction, and quality assessment were done by three independent authors. RevMan 5.3 software was used for meta-analysis. RESULTS Nine studies (n = 1831 participants) were found eligible and included in the meta-analysis. There was no difference between the both contrast media for vascular attenuation (mean difference = -21.31; 95% confidence interval -49.81 to 7.19; p = 0.14), image quality (standardized mean difference = 0.13; 95% confidence interval -0.07 to 0.33; p = 0.19), heart rate variability (standardized mean difference = -0.61; 95% confidence interval -1.30 to 0.09; p = 0.09), heat sensation (risk ratio = 0.79; 95% confidence interval 0.56 to 1.11; p = 0.17), and nausea or vomiting (risk ratio = 0.82; 95% confidence interval 0.52 to 1.28; p = 0.38). Moreover, IOCM resulted in a heart rate that was lower by 0.9 beat per minute (bpm) compared to LOCM (mean difference = -0.92; 95% confidence interval -1.81 to -0.03; p = 0.04). CONCLUSIONS Both IOCM and LOCM have similar vascular enhancement, image quality, heart rate variability, and similar risk for patient discomfort. Furthermore, IOCM resulted in a slightly lower heart rate by 0.9 bpm.
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Affiliation(s)
- Mohamed M Alhelaly
- Al-Azhar University, Damietta Faculty of Medicine, New Damietta City, Damietta, Egypt.
| | | | - Hamed Ellotf
- Al-Azhar University, Damietta Faculty of Medicine, New Damietta City, Damietta, Egypt
| | - Anas Khaled
- Al-Azhar University, Damietta Faculty of Medicine, New Damietta City, Damietta, Egypt
| | - Ahmed M Soliman
- Al-Azhar University, Damietta Faculty of Medicine, New Damietta City, Damietta, Egypt
| | - Mahmoud M Attia
- Al-Azhar University, Damietta Faculty of Medicine, New Damietta City, Damietta, Egypt
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Widmann G, Bale R, Ulmer H, Putzer D, Schullian P, Wiedermann FJ, Lederer W. Systemic Hypotension Following Intravenous Administration of Nonionic Contrast Medium During Computed Tomography: Iopromide Versus Iodixanol. Anesth Analg 2018; 126:769-775. [PMID: 28806208 DOI: 10.1213/ane.0000000000002346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In light of the increasing number of radiologic interventions performed under general anesthesia, the effects of contrast media (CM) on circulation and organ perfusion are of paramount importance. The objectives of this study were to systematically quantify effects on blood pressure, heart rate, and kidney function following intravenous administration of nonionic CM with normal and low osmolality. METHODS In this controlled, double-blinded phase IV clinical trial, 40 consecutive patients were randomly assigned to receive repeated measures of either low-osmolar iopromide or iso-osmolar iodixanol. Normal saline solution (NSS) served as control. Blood pressure and heart rate were measured continuously from 1 minute before until 3 minutes after administration of CM and NSS. Urine output was recorded hourly. RESULTS Administration of iopromide resulted in systemic hypotension lasting up to 300 seconds (105 ± 61 seconds) with the lowest mean arterial pressure of 39 mm Hg (56.7 ± 12.2 mm Hg). Iopromide caused a systolic/diastolic decrease of 31/26 mm Hg (P < .001), significant increase in heart rate (P = .042), and significant diuresis with a 2-fold higher per-hour urine output (P = .010). Administration of iodixanol and NSS had no significant influence on blood pressure (P > .640). CONCLUSIONS Administration of low-osmolar iopromide was followed by a significant transient decrease in blood pressure and a rise in heart rate. Anesthetists and radiologists should be aware of these effects in patients in whom short episodes of disturbed tissue microcirculation may pose a clinical risk.
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Affiliation(s)
| | | | - Hanno Ulmer
- Medical Statistics, Informatics and Health Economy
| | | | | | - Franz-Josef Wiedermann
- Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Lederer
- Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
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Denardo SJ, Vock DM, Schmalfuss CM, Young GD, Tcheng JE, O'Connor CM. Baseline Hemodynamics and Response to Contrast Media During Diagnostic Cardiac Catheterization Predict Adverse Events in Heart Failure Patients. Circ Heart Fail 2017; 9:CIRCHEARTFAILURE.115.002529. [PMID: 27382090 DOI: 10.1161/circheartfailure.115.002529] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 04/28/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Contrast media administered during cardiac catheterization can affect hemodynamic variables. However, little is documented about the effects of contrast on hemodynamics in heart failure patients or the prognostic value of baseline and changes in hemodynamics for predicting subsequent adverse events. METHODS AND RESULTS In this prospective study of 150 heart failure patients, we measured hemodynamics at baseline and after administration of iodixanol or iopamidol contrast. One-year Kaplan-Meier estimates of adverse event-free survival (death, heart failure hospitalization, and rehospitalization) were generated, grouping patients by baseline measures of pulmonary capillary wedge pressure (PCWP) and cardiac index (CI), and by changes in those measures after contrast administration. We used Cox proportional hazards modeling to assess sequentially adding baseline PCWP and change in CI to 5 validated risk models (Seattle Heart Failure Score, ESCAPE [Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness], CHARM [Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity], CORONA [Controlled Rosuvastatin Multinational Trial in Heart Failure], and MAGGIC [Meta-Analysis Global Group in Chronic Heart Failure]). Median contrast volume was 109 mL. Both contrast media caused similarly small but statistically significant changes in most hemodynamic variables. There were 39 adverse events (26.0%). Adverse event rates increased using the composite metric of baseline PCWP and change in CI (P<0.01); elevated baseline PCWP and decreased CI after contrast correlated with the poorest prognosis. Adding both baseline PCWP and change in CI to the 5 risk models universally improved their predictive value (P≤0.02). CONCLUSIONS In heart failure patients, the administration of contrast causes small but significant changes in hemodynamics. Calculating baseline PCWP with change in CI after contrast predicts adverse events and increases the predictive value of existing models. Patients with elevated baseline PCWP and decreased CI after contrast merit greatest concern.
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Affiliation(s)
- Scott J Denardo
- From the Division of Cardiovascular Medicine, Duke University Medical Center (S.J.D., J.E.T., C.M.O.) and Duke Clinical Research Institute (S.J.D., D.M.V., J.E.T., C.M.O.), Durham, NC; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis (D.M.V.); Section of Cardiology, North Florida/South Georgia Veterans Affairs, Gainesville, FL (C.M.S.); and Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (G.D.Y.).
| | - David M Vock
- From the Division of Cardiovascular Medicine, Duke University Medical Center (S.J.D., J.E.T., C.M.O.) and Duke Clinical Research Institute (S.J.D., D.M.V., J.E.T., C.M.O.), Durham, NC; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis (D.M.V.); Section of Cardiology, North Florida/South Georgia Veterans Affairs, Gainesville, FL (C.M.S.); and Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (G.D.Y.)
| | - Carsten M Schmalfuss
- From the Division of Cardiovascular Medicine, Duke University Medical Center (S.J.D., J.E.T., C.M.O.) and Duke Clinical Research Institute (S.J.D., D.M.V., J.E.T., C.M.O.), Durham, NC; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis (D.M.V.); Section of Cardiology, North Florida/South Georgia Veterans Affairs, Gainesville, FL (C.M.S.); and Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (G.D.Y.)
| | - Gregory D Young
- From the Division of Cardiovascular Medicine, Duke University Medical Center (S.J.D., J.E.T., C.M.O.) and Duke Clinical Research Institute (S.J.D., D.M.V., J.E.T., C.M.O.), Durham, NC; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis (D.M.V.); Section of Cardiology, North Florida/South Georgia Veterans Affairs, Gainesville, FL (C.M.S.); and Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (G.D.Y.)
| | - James E Tcheng
- From the Division of Cardiovascular Medicine, Duke University Medical Center (S.J.D., J.E.T., C.M.O.) and Duke Clinical Research Institute (S.J.D., D.M.V., J.E.T., C.M.O.), Durham, NC; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis (D.M.V.); Section of Cardiology, North Florida/South Georgia Veterans Affairs, Gainesville, FL (C.M.S.); and Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (G.D.Y.)
| | - Christopher M O'Connor
- From the Division of Cardiovascular Medicine, Duke University Medical Center (S.J.D., J.E.T., C.M.O.) and Duke Clinical Research Institute (S.J.D., D.M.V., J.E.T., C.M.O.), Durham, NC; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis (D.M.V.); Section of Cardiology, North Florida/South Georgia Veterans Affairs, Gainesville, FL (C.M.S.); and Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (G.D.Y.)
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Qian G, Yang YQ, Dong W, Cao F, Chen YD. Comparison of Iodixanol and Iopromide in Patients With Renal Insufficiency and Congestive Heart Failure Undergoing Coronary Angiography by Hemodynamic Monitoring. Angiology 2017; 68:907-913. [PMID: 28401790 DOI: 10.1177/0003319717701868] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We investigated the impact of contrast media (CM) with different osmolality on cardiac preload in patients with chronic kidney disease (CKD) and congestive heart failure (CHF). Patients with CKD and CHF were equally randomized to receive either iso-osmolar contrast media (IOCM) iodixanol or low-osmolar contrast media iopromide. We measured cardiac preload indexes by invasive hemodynamic monitoring before and after CM injection. Major adverse cardiac events postprocedures were recorded. Increase in extravascular lung water index was only seen in the iopromide group ( P < .001), while global end diastolic index and central venous pressure were all significantly increased from baseline in the both groups ( P < .001, respectively), and the increase in cardiac preload indexes was significantly greater in the iopromide group than in the iodixanol group ( P < 0.001). The overall incidence of acute heart failure was more frequently observed in the iopromide group ( P = 0.027). Low-osmolar contrast media iopromide significantly increased cardiac preload in patients with CKD and CHF undergoing cardiac catheterization procedures compared with IOCM iodixanol.
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Affiliation(s)
- Geng Qian
- 1 Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yong-Qiang Yang
- 1 Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Wei Dong
- 1 Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Feng Cao
- 1 Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yun-Dai Chen
- 1 Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
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Wilson RF. Coronary Angiography. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Comparison of a low-osmolar contrast medium, iopamidol, and an iso-osmolar contrast medium, iodixanol, in MDCT coronary angiography. Coron Artery Dis 2011; 21:414-9. [PMID: 20671550 DOI: 10.1097/mca.0b013e328338cd0b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To prospectively compare iopamidol 370, which is a low-osmolar contrast medium and iodixanol 320, which is an iso-osmolar contrast medium, in terms of image quality and nonserious adverse effects that have the potential to influence the image quality in a 16-slice multi-detector row computed tomography coronary angiography. METHODS Sixty patients were divided into two groups to receive iodixanol 320 or iopamidol 370. Image quality was assessed, using a five-point grading scale. Differences in the mean attenuation (Hounsfield units) at the origin of the coronary arteries and on the ascending aorta in both the groups were compared. The number and intensity of adverse effects were compared between the two groups. RESULTS The mean attenuation values of the ascending aorta and the origins of the coronary arteries for the two groups showed no significant difference (P≥0.41). There was no significant difference in terms of image quality between the two groups on all evaluated segments. There was a statistically significant difference in the number of adverse effects (P=0.001) between the two groups. However, in both the iodixanol group and the iopamidol group, there was no significant difference in terms of image quality between the patients with and without adverse effects. CONCLUSION The frequency of adverse effects is lower in the iodixanol group than the iopamidol group. Iodixanol 320 can provide both vascular enhancement and image quality, which is similar to iopamidol 370 in a 16-slice multi-detector row computed tomography coronary angiography. There was no significant difference in terms of overall image quality between the patients with and without adverse effects in either of the groups.
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Chartrand-Lefebvre C, White CS, Bhalla S, Mayo-Smith WW, Prenovault J, Vydareny KH, Soto JA, Ozkan OS, Chughtai AR, Soulez G. Comparison of the Effect of Low- and Iso-Osmolar Contrast Agents on Heart Rate during Chest CT Angiography: Results of a Prospective Randomized Multicenter Study. Radiology 2011; 258:930-7. [DOI: 10.1148/radiol.10100636] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Assessment of left ventricular function at rest using rubidium-82 myocardial perfusion PET: comparison of four software algorithms with simultaneous 64-slice coronary CT angiography. Nucl Med Commun 2009; 30:918-25. [DOI: 10.1097/mnm.0b013e328329fc34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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ROMANO L, GRAZIOLI L, BONOMO L, XU JR, CHEN KM, DORE R, VANZULLI A, CATALANO C. Enhancement and safety of iomeprol-400 and iodixanol-320 in patients undergoing abdominal multidetector CT. Br J Radiol 2009; 82:204-11. [DOI: 10.1259/bjr/93627766] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Effects of non-ionic iodinated contrast media on patient heart rate and pressures during intra-cardiac or intra-arterial injection. Int J Cardiol 2007; 118:389-96. [DOI: 10.1016/j.ijcard.2006.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Revised: 11/28/2006] [Accepted: 12/11/2006] [Indexed: 11/18/2022]
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Wilson RF, White CW. Coronary Angiography. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Fishman EK. Multidetector-row computed tomography to detect coronary artery disease: the importance of heart rate. Eur Heart J Suppl 2005. [DOI: 10.1093/eurheartj/sui053] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Becker CR, Knez A. Past, present, and future perspective of cardiac computed tomography. J Magn Reson Imaging 2004; 19:676-85. [PMID: 15170776 DOI: 10.1002/jmri.20072] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
In the United States, more than 1 million diagnostic invasive coronary angiograms are performed annually, and in about 50% the investigation is followed by an interventional procedure. The remaining symptomatic patients after angiography are treated conservatively or by bypass graft surgery. In recent decades coronary angiography has advanced to a fast and safe investigation. Nevertheless, in particular, patients are well aware of the small but not negligible risk of complications and the discomfort of the invasive procedure. In addition to electrocardiogram (EKG) or ultrasound stress test and thallium scintigraphy, there is further need for another noninvasive method that displays the morphology of the coronary arteries in a way that would allow the triage of patients with suspicion of coronary artery disease (CAD) for a conservative, interventional, or surgical treatment.
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Affiliation(s)
- Christoph R Becker
- Department of Clinical Radiology and Cardiology, Klinikum Grobetahadern, Munich, Germany.
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