The Comparative Hemodynamic Effects between Low Osmolar Ionic(Ioxaglate) and Non-ionic(Iopromide) Contrast Media during Left Ventriculography

BACKGROUND: Various hemodynamic changes occur during left ventriculography, such as myocardial depression, hypotension, peripheral circulatory changes, ECG changes(such as arrhythmias and conduction abnormalities) and anaphylactic reaction etc. These effects are somewhat caused by osmolality, ionic concentration of Na+, viscosity and molecular weight of contrast dye and underlying various heart disease itself during left ventriculography. We compared the hemodynamic differences between ionic(ioxaglate) and non-ionic(iopromide) low osmolar contrast agents during routine ventriculography. METHODS: In a prospective, randomized, double blind study of 124 patients underwent left ventriculography, we examined the various hemodynamic effects of the two contrast agents on left ventricle. All subjects were divided into 2 groups : ioxaglate and iopromide groups. Also, each agent was used in randomized double blind fashion in both groups ; normal control subjects(14 in ioxaglate group : 12 in iopromide group) and subjects whose ejection fraction less than 50%(12 in ioxaglate group : 16 in iopromide group). Left ventricular systolic pressure(LVSP), left ventricular end-diastolic pressure(LVEDP), maximum dP/dt, (dP/dt)/P ratio, peak - dP/dt and Tau were obtained immediately before and left ventriculography. RESULTS: 1) In total(normal+angina+MI) subjects of both groups, LVEDP(p<0.001) and maximum dP/dt(p<0.001) were increased and T(au) was reduced significantly(p<0.05). But LVSP(p<0.001) and peak - dP/dt(p<0.005) were increased significantly only in ioxaglate group. 2)In normal(control) subjects, there were no significant differences in both groups, except LVEDP that was increased by equal magnitude(p<0.001). 3) In subjects with ejection fraction less than 50%, there were no significant hemodynamic differences in both contrast agent groups bur LVEDP increased significantly in both groups(p<0.001). CONCLUSIONS: This present study showed that both ionic(ioxaglate) and non-ionic(iopromide) low osmolar contrast agents were very safe without any significant side effects except two agents caused an increase in LVEDP and did not show major differences between ioxaglate and iopromide contrast agents from a hemodynamic point of view. Two contrast agents tend to improve contractilities and diastolic properties of left ventricle since both caused an increase in maximum dP/dt and a reduce in Tau, in total subjects. This effect may be caused by cardiac compensation, probably because of osmolality, volume loading by contrast agents and secondary activation of sympathetic system immediately after injection of contrast agents. Thus, it is concluded that two ioxaglate and iopromide contrast agents amy be used safely in left ventriculography in patients with and without left ventricular dysfunction, with paying attention to an increase in LVEDP.

Changes in Plasma Dehydroepiandrosterone-Sulfate ( DHEA-S ) Level & DHEA-S / cortisol Ratio by Age in Healthy Korean / 대한내분비학회지

BACKGROUND: DHEA-S is the most abundant steroid hormone in circulation, and primarily secreted from the adrenal cortex, but its physiological role is little known. One of the characteristic features of DHEA-S is progressive decrement of plasma DHEA-S level with advancing age, in contrast, plasma levels of other adrenal hormones are not chaging or littie decreasing. To grasp the trends of plasma DHEA-S level and DHEA-S/cortisol ratio by age in healthy Korean, we measured the plasma DHEA-S levels and DHEA-S/cortisol ratios in healthy Korean. METHODS: Healthy Korean (men: 99, women: 102, age range: 15-97 year old)were studied. Subjects were not taking drugs (such as glucocorticoid or androgenic medication) or cigarettes known to modify the plasma level of DHEA-S and cortisol, and had no evidence of hepatic, renal disease or hyperlipidemia as determined by serum lipid, bilirubin, SGOT, SGPT, BUN, creatinine. Data were analyzed by 10-year age group for men and women: i.e, 10-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80-89 and 90 year or more. Plasma DHEA-S levels were measured by using a commercially available RIA kit with 125I labeled-DHEA-SO4 (Coat-A Count DHEA-SO4), and for the measurement of plasma cortisol levels, commercial Gamma Coat TM[125I] Cortisol Radioimmunassay Kit was used. RESULTS:. 1) In both men and women, plasma DHEA-S level showed high interindividual variation within the same age group. 2) There were individual sex differences in plasma levels of DHEA-S, in all age groups, plasma DHEA-S levels were significantly higher values for men than for women. 3) Maximum plasma DHEA-S levels (men; 237+-3.35 ug/dL, women; 108+-17.5 ug/dL) were at third decade in both men and women. 4) Both men and women showed the continuous decline in plasma DHEA-S level with age. These age-related decline was more prominent in men than in women (men; y=-3.152 * +292.6, r2= 0.8459, P<0.05, women; y= -1.417 * +143.3, r2 = 0.7278, P< 0.05). 5) As an index of aging, there was no stastical difference between DHEA-S and DHEA-S/cortisol ratio. CONCLUSION: In healthy Korean, there were high interindividual variation of plasrna DHEA-S levels. In both men and women plasma DHEA-S level was peak at third decade, and from when it declined progressively with age. These results suggest that although the reliability of single plasma DHEA-S measurement are limited, the decline of DHEA-S with advancing age might be a specific marker of endocrinologic hormonal milieu (aging index). Also, concerning to individual adrenal secreting capacity, we measured DHEA-S/cortisol ratio. But we did not found that plasma DHEA-S/cortisol ratio is superior to the plasma DHEA-S level as an aging index.