Subject(s)
Acute Kidney Injury/chemically induced , Acute Kidney Injury/therapy , Contrast Media/adverse effects , Radiopharmaceuticals/adverse effects , Acute Kidney Injury/prevention & control , Angiography/adverse effects , Cardiovascular Diseases/diagnostic imaging , Female , Humans , Kidney Diseases/chemically induced , Kidney Diseases/therapy , Male , Primary Prevention/methods , Prognosis , Risk AssessmentABSTRACT
Radiocontrast-induced nephropathy develops in approximately 10% to 20% of patients following administration of iodine-based dye and is one of the most prognostically detrimental complications that invasive cardiologists and radiologists encounter. Preexisting renal dysfunction and diabetes mellitus are two of the most powerful predictors of the likelihood of developing acute renal insufficiency after contrast delivery. To date, only adequate preprocedural hydration and postprocedural hydration to offset dehydration from contrast-induced diuresis have been shown to be effective in preventing this condition. Fenoldopam mesylate, a systemic vasodilator currently FDA-approved for short-term, in-hospital management of severe hypertension, has been shown to increase renal plasma flow in patients with and without chronic renal insufficiency. As a selective agonist of the dopamine-1 receptor, fenoldopam may preserve outer medullary renal blood flow and thereby attenuate radiocontrast-induced nephropathy. Small studies with fenoldopam prior to iodine-based dye administration have demonstrated low rates of radiocontrast nephropathy, and a larger, randomized trial has found that renal blood flow 1 hour after angiography rose in the fenoldopam group compared to a decline in the placebo group. The CONTRAST study has been designed to determine whether fenoldopam is indeed effective in diminishing the occurrence of radiocontrast-induced nephropathy.
Subject(s)
Acute Kidney Injury/chemically induced , Acute Kidney Injury/prevention & control , Contrast Media/adverse effects , Dopamine Agonists/therapeutic use , Fenoldopam/therapeutic use , Radiopharmaceuticals/adverse effects , Acute Kidney Injury/mortality , Adult , Aged , Coronary Angiography/adverse effects , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Reference Values , Risk Assessment , Risk Factors , Survival Analysis , Treatment OutcomeSubject(s)
Cholesterol, HDL/standards , Cholesterol, LDL/standards , Hypercholesterolemia/prevention & control , Adult , Age Factors , Aged , Coronary Disease/prevention & control , Coronary Disease/therapy , Female , Humans , Hypercholesterolemia/therapy , Male , Middle Aged , Sensitivity and Specificity , Sex FactorsSubject(s)
Aortic Valve Insufficiency/chemically induced , Appetite Depressants/adverse effects , Fenfluramine/adverse effects , Mitral Valve Insufficiency/chemically induced , Phentermine/adverse effects , Selective Serotonin Reuptake Inhibitors/adverse effects , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Insufficiency/physiopathology , Appetite Depressants/administration & dosage , Blood Flow Velocity/drug effects , Dose-Response Relationship, Drug , Echocardiography, Doppler, Color , Electrocardiography/drug effects , Female , Fenfluramine/administration & dosage , Humans , Male , Middle Aged , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/physiopathology , Myocardial Contraction/drug effects , Observation , Observer Variation , Phentermine/administration & dosage , Retrospective Studies , Risk Factors , Selective Serotonin Reuptake Inhibitors/administration & dosage , Ventricular Function, Right/drug effectsABSTRACT
Three years after the withdrawal of fenfluramine and dexfenfluramine from the market, the magnitude and prevalence of their deleterious cardiopulmonary effects remain undetermined. The links between these anorexigens and valvular heart disease and primary pulmonary hypertension, however, are clearly established. Because some evidence indicates that the valvular lesions may regress with cessation of the drug, management guidelines are still in flux. Patient reassurance and close surveillance, including serial echocardiography in selected cases, are warranted.
Subject(s)
Aminorex/analogs & derivatives , Aminorex/adverse effects , Appetite Depressants/adverse effects , Dexfenfluramine/adverse effects , Fenfluramine/adverse effects , Heart Valve Diseases/chemically induced , Hypertension, Pulmonary/chemically induced , Phentermine/adverse effects , Echocardiography , Heart Valve Diseases/diagnostic imaging , Humans , Hypertension, Pulmonary/diagnostic imagingABSTRACT
A significant source of morbidity and inhospital mortality following percutaneous coronary intervention is radiocontrast-induced nephropathy. Newer strategies, such as using low-osmolar nonionic contrast agents and selective dopamine agonists, are making it possible to greatly reduce the incidence of postcatheterization nephropathy.
Subject(s)
Acute Kidney Injury/chemically induced , Cardiac Catheterization , Contrast Media/adverse effects , Radiopharmaceuticals/adverse effects , Acute Kidney Injury/blood , Acute Kidney Injury/physiopathology , Acute Kidney Injury/prevention & control , Creatinine/blood , Dopamine Agonists/therapeutic use , Fenoldopam/therapeutic use , Humans , Risk FactorsABSTRACT
Intravascular ultrasound demonstrated plaque ruptures that occurred in regions involved with large complicated atherosclerotic plaques in the coronary artery. Because intravascular ultrasound evaluates both plaque and luminal dimensions, it contributes to our understanding of the pathophysiology of coronary artery disease.
Subject(s)
Coronary Artery Disease/diagnostic imaging , Coronary Vessels/pathology , Ultrasonography, Interventional , Coronary Artery Disease/pathology , Coronary Vessels/diagnostic imaging , Humans , Rupture, SpontaneousABSTRACT
We studied the possibility that intravenous nitroglycerin may produce heparin resistance both in vitro and prospectively in a group of 10 patients following coronary angioplasty. Nitroglycerin in physiologic to pharmacologic concentrations (41-250 micrograms/ml) did not produce heparin resistance in vitro as measured by activated partial thromboplastin time and thrombin time. The maximum reduction in activated partial thromboplastin time was 7%. In patient studies, the activated partial thromboplastin time at baseline on heparin alone (93 + 22 s) was not significantly different (p = 0.61) from activated partial thromboplastin measured upon addition of nitroglycerin (94 +/- 27 s) or 30 min following cessation of the nitroglycerin infusion while continuing the same dose of heparin (91 +/- 24 s). We conclude that intravenous nitroglycerin does not induce heparin resistance in vitro or in patients during short-term administration.