iodinated contrast
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2022 ◽  
pp. 1-9
Author(s):  
John Peabody ◽  
David Paculdo ◽  
Czarlota Valdenor ◽  
Peter A. McCullough ◽  
Eisei Noiri ◽  
...  

<b><i>Introduction:</i></b> Contrast-induced acute kidney injury (CI-AKI) is a major clinical complication of percutaneous cardiovascular procedures requiring iodinated contrast. Despite its relative frequency, practicing physicians are unlikely to identify or treat this condition. <b><i>Methods:</i></b> In a 2-round clinical trial of simulated patients, we examined the clinical utility of a urine-based assay that measures liver-type fatty acid-binding protein (L-FABP), a novel marker of CI-AKI. We sought to determine if interventional cardiologists’ ability to diagnose and treat potential CI-AKI improved using the biomarker assay for 3 different patient types: pre-procedure, peri-procedure, and post-procedure patients. <b><i>Results:</i></b> 154 participating cardiologists were randomly divided into either control or intervention. At baseline, we found no difference in the demographics or how they identified and treated potential complications of AKI, with both groups providing less than half the necessary care to their patients (46.4% for control vs. 47.6% for intervention, <i>p</i> = 0.250). The introduction of L-FABP into patient care resulted in a statistically significant improvement of 4.6% (<i>p</i> = 0.001). Compared to controls, physicians receiving L-FABP results were 2.9 times more likely to correctly identify their patients’ risk for AKI (95% CI 2.1–4.0) and were more than twice as likely to treat for AKI by providing volume expansion and withholding nephrotoxic medications. We found the greatest clinical utility in the pre-procedure and peri-procedure settings but limited value in the post-procedure setting. <b><i>Conclusion:</i></b> This study suggests L-FABP as a clinical marker for assessing the risk of potential CI-AKI, has clinical utility, and can lead to more accurate diagnosis and treatment.


2022 ◽  
Author(s):  
Jinfeng wang ◽  
Ping Fang ◽  
Jichun Liu ◽  
Youquan Wei ◽  
Xianghai Wang ◽  
...  

Abstract Aims: Conventional transseptal puncture(TSP) relies on fluoroscopy and iodinated contrast agent to distinctly position the transseptal needle at the left atrium, however, there exists great challenges in clinic in patients with contrast hypersensitivity or allergy-like reactionsin the procedure. This study aimed to evaluate a novel approach to TSP assisted by Runthrough guidewire and fluoroscopy without use of iodinated contrast agent. Methods: Sixty patients with paroxysmal atrial fibrillation undergone radiofrequency catheter ablation were enrolled from February 2021 to October 2021, and randomised to routine TSP group and Runthrough guidewire assisted group. The two groups were compared regarding the total operative time, length of fluoroscopy exposure, difference of radiation dose in X-ray, and the safety was evaluated in the patients undergone TSP without iodinated contrast agent. Results: There were no differences in baseline demographics or clinical characteristics between the two groups. Although the total procedure time[(1.98±0.29) min vs.(2.11±0.14) min, P<0.04],length of fluoroscopic exposure [(1.83±0.30) vs.(1.98±0.14), P<0.19] and radiation dose in X-ray[(27.83±3.21) uGym2vs.(29.13±1.57) uGym2, P<0.30] were somewhat statistically different between groups, yet the difference was insignificant. No complications, including pericardial tamponade and aortic perforation, occurred in all patients. Conclusion: Iodine-free TSP under the guidance of Runthrough guidewire and fluoroscopy can be a simple, safe, economical and effective approach to TSP, and may be reproduced as a novel option for TSP in patients with contrast hypersensitivity or allergy-like reactions.


Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 180
Author(s):  
Eunjung Cho ◽  
Gang-Jee Ko

Contrast-induced nephropathy (CIN) is an impairment of renal function that occurs after the administration of an iodinated contrast medium (CM). Kidney dysfunction in CIN is considered transient and reversible in most cases. However, it is the third most common cause of hospital-acquired acute kidney injury and is associated with increased morbidity and mortality, especially in high-risk patients. Diagnostic and interventional procedures that require intravascular CM are being used with increasing frequency, especially among the elderly, who can be particularly susceptible to CIN due to multiple comorbidities. Therefore, identifying the exact mechanisms of CIN and its associated risk factors is crucial not only to provide optimal preventive management for at-risk patients, but also to increase the feasibility of diagnostic and interventional procedure that use CM. CM induces kidney injury by impairing renal hemodynamics and increasing the generation of reactive oxygen species, in addition to direct cytotoxicity. Periprocedural hydration is the most widely accepted preventive strategy to date. Here, we review the latest research results on the pathophysiology and management of CIN.


Author(s):  
Jonathan James

Objective: Contrast Enhanced Spectral Mammography (CESM) breast biopsy has been recently introduced into clinical practice. This short communication describes the technique and potential as an alternative to MRI guided biopsy. Methods and materials: An additional abnormality was detected on a breast MRI examination in a patient with lobular carcinoma. The lesion was occult on conventional mammography, tomosynthesis and ultrasound and required histological diagnosis. Traditionally this would have necessitated a MRI guided breast biopsy, but was performed under CESM guidance. Results: A diagnostic CESM study was performed to ensure the lesion visibility with CESM and then targeted under CESM guidance. A limited diagnostic study, CESM scout and paired images for stereotactic targeting were obtained within a 10 min window following a single injection of iodinated contrast agent. The time from positioning in the biopsy device to releasing compression after biopsy and marker clip placement was 15 min. The biopsy confirmed the presence of multifocal breast cancer. Conclusion: CESM guided breast biopsy is a new technique that can be successfully used as an alternative to MRI guided breast biopsy. Advances in knowledge: CESM guided biopsy can be used to sample breast lesions which remain occult on standard mammography and ultrasound.


Author(s):  
Atul Kapoor ◽  
Goldaa Mahajan ◽  
Aprajita Kapoor

Abstract Objective The aim of this study was to evaluate the use of low peak kilovoltage (kVp) low-volume iodinated contrast protocol for performing coronary computed tomography (CT) angiography (CCTA) in patients using retrospective electrocardiogram (ECG) gating. Materials and Methods Hundred prospective patients undergoing CCTA were studied in two groups, A and B, using 70 kilovoltage (kV) and 120 kV protocols with half and standard intravenous volumes of injected iodinated contrast, respectively. All patients had heart rates less than 100 beats/min and body mass index (BMI) less than 31 kg/m2. Both the groups were evaluated for signal-to-noise (S/N) and contrast-to-noise (C/N) ratios along with radiation dose delivered in millisievert (mSv), and for image quality (IQ), on per patient and per segment basis. Results Patients with group A showed statistically reduced radiation dose of 1.86 mSv compared with 6.86 mSv in group B patients. Marked reduction in image noise with statistically improved S/N and C/N ratios in all coronary vessels was seen in group A. S/N ratios in group A were 20.25, 18.68, 19.04, 17.41, and 18.69 for aorta, left main, left anterior descending, right coronary, and left circumflex arteries while they were 13.34, 11.12, 10.96, 9.74, and 8.67 in group B patients. C/N ratios were also higher in all vessels in group A patients, that is, 19.48, 19.48, 19.04, 19.48, and 17.68, compared with group B patients, who had 12.43, 10.03, 9.23, 9.57, and 8.23 ratios (p < 0.0001). No significant difference in IQ per patient and per vessel was seen between both the groups. Discussion Retrospective ECG-gated low-kVp low-volume iodinated contrast protocol provides good diagnostic quality angiograms in patients with BMI up to 31 kg/m2 and with heart rates of less than 100 beats/min with three times reduced radiation dose. The reduced volume of contrast reduces the cost as well as the chance of contrast-induced nephropathy.


2022 ◽  
Vol 7 (1) ◽  
pp. 361
Author(s):  
Abdurrahman Hasyim Asy’ari ◽  
Anny Setijo Rahaju ◽  
Arifa Mustika

This research aimed to analyze the histopathology (tubular necrosis and proteinaceous casts) and renal function (SCr and BUN) differences of male Wistar strain white rats (Rattus norvegicus) after intravascular injection of iodinated contrast media Iohexol and Iopamidol. This research is an experimental laboratory with a post-test only control group design. Male Wistar rats that fit the criteria were divided into three groups by random sampling technique: Control (K), Treatment 1 (P1, Iohexol 350 mg iodine/mL), and Treatment 2 (P2, Iopamidol 370 mg iodine/mL). Iohexol and Iopamidol were injected at a dose of 1600 mg iodine/kg BW. The histopathology differences were observed under a light microscope with a magnification of 400x, which were analyzed semi-quantitatively through slides formed by the paraffin method and H&E staining. SCr and BUN levels were checked using an automatic analysis machine with blood samples taken through the cardiac ventricle. Kruskal-Wallis test (α= 0.05) on renal histopathology scores, both tubular necrosis and protein casts showed Asymp. Sig. value > 0.05, which means there is no significant difference between the groups (K, P1, and P2). Kruskal-Wallis test (α= 0.05) on SCr levels also showed the Asymp. Sig. value > 0.05 and One-Way ANOVA Comparative Test on BUN levels showed the Sig. value > 0.05 which means there is no significant difference in renal function between the groups. This study proved no difference in histopathology and renal function in Wistar rats after injection of iodinated contrast media Iohexol and Iopamidol.


Vascular ◽  
2022 ◽  
pp. 170853812110682
Author(s):  
Eelin Wilson ◽  
Yoni Sacknovitz ◽  
Varun Dalmia ◽  
Omar Sanon ◽  
Ayesha Hatch ◽  
...  

Objective Previous studies have demonstrated that low contrast volume used in access-related interventions had limited effects on the progression of chronic kidney disease (CKD) after fistulography, but studies are limited and heterogeneous. We sought to evaluate the rate of and factors associated with progression to dialysis (HD) within 1 month after fistulography for patients with advanced CKD. Methods A single-institution retrospective cohort analysis of patients with CKD stage IV and V, not yet on HD, undergoing fistulography from 1 January 2014 to 31 December 2018 was performed. The primary outcome was progression to HD within 1 month. Additional variables and the association with the primary outcome such as medical comorbidities, contrast type or volume were assessed. Results A total of 34 patients underwent 41 fistulograms prior to HD initiation. Progression to HD within 1 month of fistulogram occurred in seven patients (all CKD V). The mean time between fistulogram and HD was 271 days for 31 of 34 patients who ultimately progressed to HD. Those with CKD IV began HD in 549 days on average, while those with CKD V began HD in 190 days on average. Three patients had not initiated HD at a mean of 539 days of follow-up. The only factors associated with progression to HD within 1 month included use of isovue ( p = .005) and elevated contrast volume, with a mean of 40 mL ( p = .027). Conclusion Although none of the patients with CKD IV required HD within 1 month after fistulogram, the use of larger iodinated contrast volume was associated with progression to HD within 1 month of fistulography for patients with CKD V. Further studies should investigate the safety of iodinated and alternative (e.g., carbon dioxide) contrast media in fistulography or duplex-based HD access procedures for CKD patients, especially CKD V, not yet on HD.


2021 ◽  
Author(s):  
Yasutada Akiba ◽  
Angela M. Leung ◽  
Muhammad-Tariq Bashir ◽  
Ramin Ebrahimi ◽  
Jesse W. Currier ◽  
...  

Abstract The lactoperoxidase (LPO)-hydrogen peroxide-halides reaction (LPO system) converts iodide and thiocyanate (SCN-) into hypoiodous acid (HOI) and hypothiocyanite (OSCN-), respectively. Since this system has been implicated in defense of the airways and oropharynx from microbial invasion, we measured the concentrations of these analytes in human saliva before and after iodine administration to test the hypothesis that an iodide load increases salivary iodide and HOI concentrations. Salivary iodide, SCN-, HOI and OSCN- were measured using standard methodology. Salivary iodide and HOI levels significantly increased after iodinated contrast injection compared with baseline levels, whereas there was no significant change in salivary SCN- and OSCN- levels. The contrast dye iodine load and changes of salivary iodide and HOI levels were positively correlated, suggesting that higher iodide in the circulation increases iodide output and salivary HOI production. Excess iodine exposure in humans increases the salivary output of iodide, increasing salivary HOI concentrations with no effect on SCN-/OSCN- levels. This first of its kind study suggests that a sufficient but safe iodide supplementation may augment the generation of antimicrobial HOI by the salivary LPO system against airborne viral pathogens, including coronaviruses and influenza viruses, a possible inexpensive means of effectively curbing viral pandemics.


2021 ◽  
Author(s):  
Boshra Elbaz ◽  
Hala Elmarsafawy ◽  
Wafaa Laimon

Abstract This study aims to determine the incidence, potential onset and clinical course of hypothyroidism following cardiac catheter (CC) in infants with congenital heart diseases (CHD) and to evaluate the predictors for hypothyroidism in this vulnerable group. This prospective study included 102 patients with CHD, aged ≤ 3 years who underwent CC. Thyroid function tests were assessed before CC, one day, one week, two weeks and four weeks after the procedure. 12% of the studied group showed hypothyroidism four weeks after CC. Univariate analysis revealed that the significant predictors of hypothyroidism following CC are aortic stenosis (RR=10.0 (1.49-66.99), P=0.018), duration of fluoroscopy (RR=1.12 (0.99-1.26), P=0.05), and total cumulative dose of iodinated contrast media (iCM) (RR=1.01 (1.003 -1.01), P=0.019). Multivariate analysis revealed that iCM cumulative dose was the only significant predictor of developing hypothyroidism (RR=1.00 (1.00-1.01), P=0.04). ROC curve analysis showed that the cut-off point of iCM dose for prediction of hypothyroidism evolution is 8.7 gm/kg (26.1 ml/kg), (sensitivity: 83.3%, specificity: 65.1%), while the cut-off point of fluoroscopy duration which predicts development of hypothyroidism is 24 minutes, (sensitivity: 83.3%, specificity: 65.9%). In a median follow-up duration of 20 months, acquired hypothyroidism after CC persists in 5% of this cohort. Conclusion: Exposure to higher dose of iCM and longer duration of fluoroscopy during CC are risk factors for evolution of hypothyroidism. We recommend assessment of thyroid profile 4 weeks after CC particularly in patients who received a dose of iCM higher than 8.7 gm/kg and/or exposed to fluoroscopy for more than 24 minutes.


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