Abstract:
BACKGROUND:Controversy exists as to whether low-osmolality radiographic contrast agents, which have less detrimental pharmacological effects but are considerably more expensive than high-osmolality agents, should be used universally or only for selected high-risk patients. METHODS AND RESULTS:A randomized, double-blind study was used to compare the frequency and severity of adverse events in 2245 consecutive patients undergoing diagnostic cardiac angiography. Two thousand one hundred sixty-six patients were successfully randomized to either iohexol, a low-osmolality contrast agent, or diatrizoate (as Hypaque 76), a high-osmolality agent. The end point event included clinically important adverse events (which jeopardized the patient or required aggressive treatment), contrast agent-related procedure abbreviations, and conversion to open-label contrast agent. Clinically important end point events were associated with increased age, New York Heart Association functional class, left ventricular end-diastolic pressure, arteriovenous oxygen difference, severity of coronary artery disease, and history of a previous reaction to contrast agent. End point events were less frequent in patients receiving iohexol (2.6% versus 4.6%; adjusted odds ratio, 1.59; 95% confidence interval, 0.97-2.60; P = .07). The difference in event frequency between iohexol and diatrizoate was confined to the highest-risk quartile of the patient population. An algorithm was developed to classify patients as being at high or low risk for an event based on patient age, New York Heart Association class, history of a prior contrast reaction, and left ventricular end-diastolic pressure. Application of this algorithm for selective use of low-osmolality agents only for high-risk patients to a theoretical population of 1000 patients reduced contrast agent costs 66% without increasing the frequency of contrast agent-related adverse events. CONCLUSIONS:The advantages of low-osmolality contrast agents are clinically important in patients with severe heart disease but are not in less ill patients. Universal use of low-osmolality agents for cardiac angiography in an unselected population is not necessary. Appropriately guided selective use of low-osmolality contrast agents is feasible and has the potential to reduce cost substantially without compromising safety or effectiveness.
journal_name
Circulationjournal_title
Circulationauthors
Matthai WH Jr,Kussmaul WG 3rd,Krol J,Goin JE,Schwartz JS,Hirshfeld JW Jrdoi
10.1161/01.cir.89.1.291subject
Has Abstractpub_date
1994-01-01 00:00:00pages
291-301issue
1eissn
0009-7322issn
1524-4539journal_volume
89pub_type
临床试验,杂志文章,随机对照试验相关文献
CIRCULATION文献大全abstract:BACKGROUND:ST-segment depression during exercise testing is frequently observed in the absence of restenosis after coronary angioplasty. METHODS AND RESULTS:We studied the determinants of this phenomenon in 70 consecutive patients with unstable angina related to a single left anterior descending coronary artery lesion...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.90.1.148
更新日期:1994-07-01 00:00:00
abstract:BACKGROUND:The long-term outcomes of off-pump coronary artery bypass grafting (CABG) are the subject of speculation. Our institution has >15 years of experience performing CABG both off-pump (OPCAB) and on cardiopulmonary bypass (CPB). Our null hypothesis was that there would be no difference in a long-term composite o...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.116.021933
更新日期:2016-10-25 00:00:00
abstract:BACKGROUND:Research published in Circulation has shown that cardiac mortality is highest during December and January. We investigated whether some of this spike could be ascribed to the Christmas/New Year's holidays rather than to climatic factors. METHODS AND RESULTS:We fitted a locally weighted polynomial regression...
journal_title:Circulation
pub_type: 杂志文章,评审
doi:10.1161/01.CIR.0000151424.02045.F7
更新日期:2004-12-21 00:00:00
abstract:BACKGROUND:Denervation supersensitivity has been proposed as a mechanism for the relation between ventricular arrhythmias and the sympathetic nervous system. Evaluation of this phenomenon in humans has become feasible only recently with the development of noninvasive scintigraphic methods for evaluating the pattern of ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.88.1.172
更新日期:1993-07-01 00:00:00
abstract:BACKGROUND:Previous studies have demonstrated that induction of heat shock protein (HSP) 72 by whole-body hyperthermia reduces infarct size in an in vivo model of ischemia and reperfusion. Furthermore, hearts obtained from transgenic mice that overexpress HSP72 demonstrate improved functional recovery and decreased inf...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.94.6.1408
更新日期:1996-09-15 00:00:00
abstract::Global ventricular function was evaluated by both multiple gated cardiac blood pool scans (MUGA) and contrast ventriculograms in a group of 17 patients with suspected coronary artery disease. The contrast ventriculograms were analyzed frame by frame to generate a volume versus time curve for each patient, while the tr...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.56.6.1024
更新日期:1977-12-01 00:00:00
abstract:BACKGROUND:The timing of onset of angina before myocardial infarction in relation to outcome is unknown. METHODS AND RESULTS:We prospectively determined the importance of the time of onset of preinfarction angina in relation to 30-day outcomes in the TIMI-9B study from standardized forms. Of the 3002 patients entered ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.97.11.1042
更新日期:1998-03-24 00:00:00
abstract:BACKGROUND:Patients with heart failure and systolic dysfunction may develop disordered breathing during sleep. Repeated episodes of apnea and hypopnea may result in desaturation and arousals, which could adversely affect left ventricular function. The purpose of this study was to determine the short-term effects of con...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.101.4.392
更新日期:2000-02-01 00:00:00
abstract:BACKGROUND:Cardiac vagal predominance increases the RR interval and RR high-frequency (HF) variability during non-rapid eye movement (non-REM) sleep (stages I through IV) in young subjects. Aging suppresses deep sleep, but effects of age-related changes in sleep architecture on RR are unknown. Whether mechanical effect...
journal_title:Circulation
pub_type: 临床试验,杂志文章
doi:10.1161/01.cir.103.1.84
更新日期:2001-01-02 00:00:00
abstract:BACKGROUND:We reported that HDL loses its antiinflammatory properties during acute influenza A infection in mice, and we hypothesized that these changes might be associated with increased trafficking of macrophages into the artery wall. The present study tested this hypothesis. METHODS AND RESULTS:D-4F, an apolipoprot...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.0000030182.35880.3e
更新日期:2002-08-27 00:00:00
abstract:BACKGROUND:Current guidelines recommend mitral valve surgery for asymptomatic patients with severe degenerative mitral regurgitation and preserved left ventricular systolic function when exercise pulmonary hypertension (PHT) is present. However, the determinants of exercise PHT have not been evaluated. The aim of this ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.110.938241
更新日期:2010-07-06 00:00:00
abstract:BACKGROUND:Heart failure (HF) with preserved ejection fraction (HFpEF) is a heterogeneous syndrome. Phenotyping patients into pathophysiologically homogeneous groups may enable better targeting of treatment. Obesity is common in HFpEF and has many cardiovascular effects, suggesting that it may be a viable candidate for...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.116.026807
更新日期:2017-07-04 00:00:00
abstract::Congestive heart failure is often preceded by a latent or preclinical phase in which patients are relatively asymptomatic. During this period, there is neuroendocrine activation, left ventricular dysfunction, and remodeling of the heart. The extent to which these activities are interrelated is unclear, but it appears ...
journal_title:Circulation
pub_type: 杂志文章,评审
doi:
更新日期:1993-05-01 00:00:00
abstract:BACKGROUND:Dynamic intraventricular flow velocities after valve replacement for aortic stenosis have been associated with high in-hospital morbidity and mortality. The aims of the present study were to determine the mechanisms and preoperative predictors of abnormal flow velocity (AFV) after valve replacement for aorti...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.93.4.712
更新日期:1996-02-15 00:00:00
abstract:BACKGROUND:Tissue-type plasminogen activator (tPA) and urokinase-type plasminogen activator (uPA) are thought to play critical roles in vascular remodeling after injury, with tPA mediating intravascular clot lysis and uPA modulating cell migration within the vessel wall. In human vascular disease, however, thrombus org...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.0000031162.80988.2b
更新日期:2002-10-01 00:00:00
abstract:BACKGROUND:Although the left prepectoral site is preferred for "hot can" placement, this site is unavailable in some patients. We evaluated the influence of electrode location on defibrillation thresholds with alternative hot can and transvenous lead configurations. METHODS AND RESULTS:Three interrelated studies were ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.96.12.4400
更新日期:1997-12-16 00:00:00
abstract::Two patients with supraventricular parasystole (one atrioventricular and one auricular) are reported. In both patients, reentrant extrasystoles appeared to occur as the result of Mobitz type I second-degree entrance block. We believe that when a sinus impulse fell soon after the absolute refractory period of the pathw...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.65.1.208
更新日期:1982-01-01 00:00:00
abstract::Esophageal perforation is a dreaded complication of atrial fibrillation ablation that occurs in 0.1% to 0.25% of atrial fibrillation ablation procedures. Delayed diagnosis is associated with the development of atrial-esophageal fistula (AEF) and increased mortality. The relationship between the esophagus and the left ...
journal_title:Circulation
pub_type: 杂志文章,评审
doi:10.1161/CIRCULATIONAHA.117.025827
更新日期:2017-09-26 00:00:00
abstract::We evaluated high-energy phosphate (HEP) levels and the ability to perform work in rat hearts preserved by standard techniques (0.9% NaCl arrest and storage at 4 degrees C) and by continuous coronary perfusion at 22 degrees C, pH 7.25, and 55 mm Hg for 4 or 8 hr with Krebs-Henseleit buffer (KHB), modified Morgan's sol...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1986-11-01 00:00:00
abstract::Since quinidine is one of the few agents available to treat and prevent ventricular arrhythmias in ambulatory patients, its hemodynamic effects have been reevaluated. When given in therapeutic doses to anesthetized mongrel dogs, quinidine significantly reduced heart rate, aortic pressure and flow, but it did not signi...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.53.1.101
更新日期:1976-01-01 00:00:00
abstract:BACKGROUND:Platelet activation plays a pivotal role in the pathogenesis of acute coronary disease. Monocytes are involved in the progression of atherosclerosis and are potent activators of blood coagulation through their ability to synthesize tissue factor (TF). The aim of this study was to compare markers of monocyte ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.90.4.1662
更新日期:1994-10-01 00:00:00
abstract:BACKGROUND:Fixed-dose unmonitored treatment with dabigatran etexilate is effective and has a favorable safety profile in the prevention of stroke in atrial fibrillation patients compared with warfarin. We hypothesized that genetic variants could contribute to interindividual variability in blood concentrations of the a...
journal_title:Circulation
pub_type: 杂志文章,随机对照试验
doi:10.1161/CIRCULATIONAHA.112.001233
更新日期:2013-04-02 00:00:00
abstract::Optimal electrode position for long-term transvenous cardiac pacing is in the apex of the right ventricle. Intracardiac electrograms, surface electrocardiograms, frontal fluoroscopy, lateral roentgenograms, and pacing threshold levels were studied in two groups of patients: One group was comprised of five patients wit...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.42.4.701
更新日期:1970-10-01 00:00:00
abstract:BACKGROUND:It remains unclear how mineralocorticoids induce cardiac hypertrophy and fibrosis. Recently, activation of the calcium-dependent phosphatase, calcineurin, has been shown to induce cardiac hypertrophy. In the present study, we examine the role of calcineurin in mineralocorticoid-induced cardiac hypertrophy an...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/hc0602.104675
更新日期:2002-02-12 00:00:00
abstract:BACKGROUND:Regional variation in the incidence and outcomes of in-hospital cardiac arrest (IHCA) is not well studied and may have important health and policy implications. METHODS AND RESULTS:We used the 2003 to 2011 Nationwide Inpatient Sample databases to identify patients≥18 years of age who underwent cardiopulmona...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.114.014542
更新日期:2015-04-21 00:00:00
abstract::To determine whether alteration of intrinsic myocardial stiffness is responsible for the reduction of left ventricular filling pressure and volume by nifedipine in patients with impaired baseline ventricular function, we evaluated the hemodynamic responses in 32 patients undergoing diagnostic cardiac catheterization. ...
journal_title:Circulation
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1161/01.cir.74.1.126
更新日期:1986-07-01 00:00:00
abstract:BACKGROUND:We tested the hypothesis that combined cyclooxygenase-1 (COX-1) and prostacyclin synthase (PGIS) gene transfer selectively augments prostacyclin production without a concurrent overproduction of other prostanoids. METHODS AND RESULTS:ECV304 cells were transfected with bicistronic pCOX-1/PGIS versus pCOX-1 o...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.103.16.2090
更新日期:2001-04-24 00:00:00
abstract:BACKGROUND:Mutations in the ryanodine 2 receptor (RyR2) gene have been identified in patients with catecholaminergic polymorphic ventricular tachycardia. We examined the cellular basis for the ECG features and arrhythmia mechanisms using low-dose caffeine to mimic the defective calcium homeostasis encountered under the...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.104.479295
更新日期:2005-05-31 00:00:00
abstract:BACKGROUND:Myocardial perfusion reflects the macro- and microvascular coronary circulation. Recent quantitation developments using cardiovascular magnetic resonance perfusion permit automated measurement clinically. We explored the prognostic significance of stress myocardial blood flow (MBF) and myocardial perfusion r...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.119.044666
更新日期:2020-04-21 00:00:00
abstract::Cardiac output and pressure-flow measurements were made in left internal mammary artery-to-left anterior descending coronary artery grafts and left subclavian artery-to-left circumflex coronary artery vein grafts after proximal coronary artery ligation. Similar measurements were also made in left internal mammary arte...
journal_title:Circulation
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1975-08-01 00:00:00