A Multicenter, Open-Label Study of an Intravenous Short-Acting β1-Adrenergic Receptor Antagonist Landiolol Hydrochloride for Coronary Computed Tomography Angiography by 16-Slice Multi-Detector Computed Tomography in Japanese Patients with Suspected Ischemic Cardiac Disease

Abstract

BackgroundDuring coronary computed tomography (CT) angiography (CCTA), β-blockers (β-adrenergic receptor antagonists) have commonly been used to lower heart rate and improve image quality.ObjectivesThe aim of this study was to investigate the image quality-improving effect as well as the heart rate-lowering effect of landiolol hydrochloride (an intravenous short-acting β1-adrenergic receptor antagonist) in CCTA by 16-slice multi-detector CT (MDCT).MethodsA total of 39 subjects suspected of having ischemic cardiac disease and requiring CCTA received 0.125 mg/kg of landiolol hydrochloride to study the efficacy and safety of landiolol hydrochloride in a multicenter open-label clinical study. The endpoint was the diagnosable proportion (proportion of subjects whose coronary stenosis was diagnosable).ResultsThe diagnosable proportions for the reconstruction images at mid-diastole were 56.0 %. The diagnosable proportions for the optimal reconstruction images were 65.4 %. The mean heart rate-lowering effect was observed soon after administration of landiolol hydrochloride; the peak of the effect was reached in 3–5 min, and the effect wore off in 30 min after completion of administration. The mean heart rate-lowering proportion at that time was −14.46 ± 8.4 %.ConclusionsLandiolol hydrochloride was confirmed to reduce heart rate significantly and rapidly after intravenous injection and this suggests that the study drug is a safe and useful agent for improving the image quality of CCTA by 16-slice MDCT.

Effect of Landiolol Hydrochloride on Hemodynamics in a Histamine-Induced Shock Model

“…We selected pentobarbital anesthesia because, in a previous review of anesthetic conditions, heart rate reduction by landiolol in clinical settings could not be clearly confirmed with nitrous oxide or isoflurane, which independently reduced the heart rate. Landiolol, which is administered to reduce the heart rate during CCTA, causes an approximately 20% reduction within 3-5 min after administration [10][11][12][13] . Thus, pentobarbital, which activates the sympathetic nervous system, fits the clinical settings in which contrast media and landiolol are administered in combination.…”

“…The pharmacokinetic profile of landiolol reveals that this compound has high β1 selectivity and a very short circulating half-life (3.97 min) [9]. Consequently, it can be used as a β-blocking agent to increase the diagnosable proportion of patients undergoing CCTA because it decreases the effect of motion artifacts induced by the heart rate and does not exhibit a prolonged β-blocking effect after examination [10][11][12][13].…”

Safety of Landiolol Hydrochloride as a Premedication for Producing an Appropriate Heart Rate for Multidetector-Row Computed Tomography Coronary Angiography

“…It has been shown to be both safe and effective for urgent use in patients with tachyarrhythmia during the perioperative phase [ 13 ]. In addition, intravenous administration of landiolol hydrochloride has been used as a premedication for producing an appropriate HR for CTA without any adverse hemodynamic or physical effects [ 8 , 9 , 14 ]. Although premedication of landiolol hydrochloride resulted in significant reduction of BP, there were no serious adverse effects throughout CTA in all patients.…”

A landiolol alkalmazási lehetőségei a kardiológiai és intenzív terápiás ellátásban

“…Hasonló eredményről számolt be Hirano munkacsoportja 39 beteget vizsgálva. A CT-vizsgálat előtt közvetlenül alkalmazott intravénás bolus landiolol (0,125 mg/ ttkg) hatására a szívfrekvencia 77,1 ± 9,8/percről 65,4 ± 8,0/percre csökkent (p<0,0001), ami lehetővé tette a betegek 65,4%-ánál, hogy a coronaria-CT-angiográfiás vizsgálatra kevésbé optimális, 16 szeletes CT-vel is kielégítő minőségű képek készülhessenek [54]. Hirano egy másik, 258 fős, prospektív, randomizált, multicentrikus, placebokontrollált vizsgálatában is megerősítette, hogy a coronaria-CT-angiográfiás vizsgálat előtt közvetlenül alkalmazott, 0,125 mg/ttkg bolus landiolol a placebóhoz képest szignifikánsan csökkenti a szívfrekvenciát (-19,1 ± 8,1/min vs. -5,9 ± 9,7/perc, p<0,0001).…”