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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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Fu JJ, Guo JJ, Qin AP, Yu XY, Zhang Q, Lei XP, Huang YG, Chen MY, Li JX, Zhang Y, Liu JP, Dang YY, Wu D, Zhao XY, Lin ZX, Lin YL, Li SP, Zhang LY. Bismuth chelate as a contrast agent for X-ray computed tomography. J Nanobiotechnology 2020; 18:110. [PMID: 32762751 PMCID: PMC7412782 DOI: 10.1186/s12951-020-00669-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/30/2020] [Indexed: 01/12/2023] Open
Abstract
Backgrounds Due to the unexpected side effects of the iodinated contrast agents, novel contrast agents for X-ray computed tomography (CT) imaging are urgently needed. Nanoparticles made by heavy metal elements are often employed, such as gold and bismuth. These nanoparticles have the advantages of long in vivo circulation time and tumor targeted ability. However, due to the long residence time in vivo, these nanoparticles may bring unexpected toxicity and, the preparation methods of these nanoparticles are complicated and time—consuming. Methods In this investigation, a small molecular bismuth chelate using diethylenetriaminepentaacetic acid (DPTA) as the chelating agent was proposed to be an ideal CT contrast agent. Results The preparation method is easy and cost—effective. Moreover, the bismuth agent show better CT imaging for kidney than iohexol in the aspect of improved CT values. Up to 500 µM, the bismuth agent show negligible toxicity to L02 cells and negligible hemolysis. And, the bismuth agent did not induce detectable morphology changes to the main organs of the mice after intravenously repeated administration at a high dose of 250 mg/kg. The pharmacokinetics of the bismuth agent follows the first—order elimination kinetics and, it has a short half—life time of 0.602 h. The rapid clearance from the body promised its excellent biocompatibility. Conclusions This bismuth agent may serve as a potential candidate for developing novel contrast agent for CT imaging in clinical applications.
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Affiliation(s)
- Ji-Jun Fu
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China. .,School of Materials Science and Energy Engineering, Foshan University, Foshan, 528000, China.
| | - Jun-Jie Guo
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Medical Imaging, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Ai-Ping Qin
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Xi-Yong Yu
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Qiang Zhang
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Xue-Ping Lei
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Yu-Gang Huang
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Ming-Yue Chen
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Jie-Xia Li
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Yu Zhang
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Jing-Ping Liu
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yuan-Ye Dang
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Dan Wu
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Xiao-Ya Zhao
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Zhong-Xiao Lin
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Yin-Lei Lin
- School of Materials Science and Energy Engineering, Foshan University, Foshan, 528000, China
| | - Song-Pei Li
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China.
| | - Ling-Yan Zhang
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China.
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Werner S, Bez C, Hinterleitner C, Horger M. Incidence of contrast-induced acute kidney injury (CI-AKI) in high-risk oncology patients undergoing contrast-enhanced CT with a reduced dose of the iso-osmolar iodinated contrast medium iodixanol. PLoS One 2020; 15:e0233433. [PMID: 32437415 PMCID: PMC7241755 DOI: 10.1371/journal.pone.0233433] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 05/05/2020] [Indexed: 12/18/2022] Open
Abstract
Objectives To determine the incidence of post-contrast acute kidney injury (PC-AKI) and presumed contrast-induced acute kidney injury (CI-AKI) following contrast-enhanced CT (CECT) with intravenous application of a reduced dose of the iso-osmolar contrast agent iodixanol in cancer patients with chronic kidney disease. Methods 198 oncology patients with a baseline estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2 undergoing a total of 237 CECTs using a reduced dose of 60ml iodixanol were retrospectively analyzed. Statistical analysis was performed for the entire cohort and subgroups. The effect of additional risk factors on the occurrence of PC-AKI was evaluated. Results The overall PC-AKI incidence was 6.3%. Excluding patients with concurrent medical conditions known to directly and independently impact kidney function and patients with AKI preceding the CT-scan resulted in a presumed CI-AKI incidence of 3.8%. No permanent post-contrast worsening of renal function and no AKI treatment were required. Subgroups considering baseline eGFR yielded PC-AKI incidences of 4.6% (eGFR 45-60ml/min/1.73m2, n = 130), 7.4% (eGFR 30-45ml/min/1.73m2, n = 95) and 16.7% (eGFR <30ml/min/1.73m2, n = 12). Additional patient related risk factors did not show any significant effect on the occurrence of PC-AKI. Conclusions Low incidences of PC-AKI/CI-AKI suggest that a reduced dose of an iso-osmolar contrast agent is safe in high-risk oncological patients with impaired renal function.
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Affiliation(s)
- Sebastian Werner
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
- * E-mail:
| | - Christian Bez
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Clemens Hinterleitner
- Department of Internal Medicine II–Haematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
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Zhang P, Li WY, Yang SC, Fu NK, Liu XG, Zhang X, Cong HL, Lin WH, Tian FS, Lu CZ, Zhang J. Preventive Effects of Nicorandil Against Contrast-Induced Nephropathy in Patients With Moderate Renal Insufficiency Undergoing Percutaneous Coronary Intervention. Angiology 2019; 71:183-188. [PMID: 30987432 DOI: 10.1177/0003319719841733] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We investigated the preventive effect of nicorandil on contrast-induced nephropathy (CIN) in patients with moderate renal insufficiency undergoing percutaneous coronary intervention (PCI). A total of 250 patients with a creatinine clearance (crCl) ≤60 mL/min undergoing PCI were randomly assigned to either a nicorandil group (nicorandil 10 mg 3 times/d and hydration; n = 125) or a control group (hydration only; n = 125). The first end point was the incidence of CIN defined as an increase in serum creatinine (Scr) levels by ≥0.5 mg/dL or ≥25% within 72 hours after exposure to the contrast medium. The secondary end points were (1) changes in Scr, blood urea nitrogen, and crCl and (2) the incidence of major adverse events during hospitalization. The incidence of CIN was 1.6% (2/125) in the nicorandil group and 9.6% (12/125) in the control group ( P = .011). There was no obvious difference in the incidence of major adverse events during hospitalization between the nicorandil and the control group (4.0% vs 4.8%, P = 1.000). Multivariate logistic regression analysis showed that nicorandil was a protective factor for CIN (odds ratios = 0.126, 95% confidence interval: −19.996 to −0.932, P = .012). Prophylactic administration of nicorandil may prevent against CIN in patients with moderate renal insufficiency undergoing PCI.
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Affiliation(s)
- Peng Zhang
- Graduate School of Tianjin Medical University, Tianjin, China
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Wen-yuan Li
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Shi-Cheng Yang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Nai-Kuan Fu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Xiao-Gang Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Xue Zhang
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Hong-Liang Cong
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Wen-Hua Lin
- Department of Cardiology, Taida International Cardiovascular Hospital, Tianjin, China
| | - Feng-Shi Tian
- Department of Cardiology, Tianjin Fourth Central Hospital, Tianjin, China
| | - Cheng-Zhi Lu
- Department of Cardiology, Tianjin First Central Hospital, Tianjin, China
| | - Jing Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
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Fu N, Yang S, Zhang J, Zhang P, Liang M, Cong H, Lin W, Tian F, Lu C. The efficacy of probucol combined with hydration in preventing contrast-induced nephropathy in patients with coronary heart disease undergoing percutaneous coronary intervention: a multicenter, prospective, randomized controlled study. Int Urol Nephrol 2017; 50:105-112. [PMID: 29071556 DOI: 10.1007/s11255-017-1718-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 10/06/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate the preventive effect of probucol combined with hydration on contrast-induced nephropathy (CIN) in patients with coronary heart disease undergoing percutaneous coronary intervention (PCI). METHODS A total of 641 patients undergoing PCI were randomly assigned to either a probucol group (probucol 500 mg twice daily and hydration; n = 321) or a control group (hydration only; n = 320). The primary endpoint was the incidence of CIN, defined as an increase in serum creatinine (Scr) by ≥ 44.2 μmol/L or ≥ 25% within 72 h after the administration of contrast agent. Secondary endpoints were changes in Scr, cystatin-C (Cys-C), creatinine clearance rate (Ccr), C-reactive protein (CRP), superoxide dismutase (SOD), and glutathione (GSH) within 72 h, and major adverse events during hospitalization or the 14-day follow-up period. RESULTS The incidence of CIN was 4.0% (13/321) in the probucol group and 10.9% (35/320) in the control group. The probucol group had lower Cys-C and higher Ccr at 48 and 72 h after PCI compared with the control group. At 48 and 72 h following the operation, Cys-C and CRP were lower in the probucol group compared with the control group, but Ccr, SOD, and GSH were higher. There were no differences in the incidence of major adverse events during hospitalization or the 14-day follow-up between the groups. Multivariate logistic regression analysis showed that probucol was an independent protective factor for CIN. CONCLUSIONS Probucol combined with hydration more effectively decreased the incidence of CIN in patients with coronary heart disease undergoing PCI compared with hydration alone.
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Affiliation(s)
- Naikuan Fu
- Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China
| | - Shicheng Yang
- Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China
| | - Jing Zhang
- Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China.
| | - Peng Zhang
- Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China
| | - Min Liang
- Tianjin Medical University, Tianjin, China
| | - Hongliang Cong
- Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China
| | - Wenhua Lin
- Department of Cardiology, Teda International Cardiovascular Hospital, Tianjin, China
| | - Fengshi Tian
- Department of Cardiology, Tianjin Fourth Central Hospital, Tianjin, China
| | - Chengzhi Lu
- Department of Cardiology, Tianjin First Central Hospital, Tianjin, China
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Yang SC, Fu NK, Zhang J, Liang M, Cong HL, Lin WH, Tian FS, Lu CZ, Sun TT, Zhang WY, Ma ZH. Preventive Effects of Alprostadil Against Contrast-Induced Nephropathy Inpatients With Renal Insufficiency Undergoing Percutaneous Coronary Intervention. Angiology 2017; 69:393-399. [PMID: 29073785 DOI: 10.1177/0003319717730942] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
| | - Nai-Kuan Fu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Jing Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Min Liang
- Tianjin Medical University, Tianjin, China
| | - Hong-Liang Cong
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Wen-Hua Lin
- Department of Cardiology, Taida International Cardiovascular Hospital, Tianjin, China
| | - Feng-Shi Tian
- Department of Cardiology, Tianjin Fourth Central Hospital, Tianjin, China
| | - Cheng-Zhi Lu
- Department of Cardiology, Tianjin First Central Hospital, Tianjin, China
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