Feasibility of Intravenous Administration of Landiolol Hydrochloride for Multislice Computed Tomography Coronary Angiography Initial Experience

Abstract

ultislice computed tomography (MSCT) coronary angiography (CAG) is emerging as a powerful noninvasive imaging strategy for the evaluation of atherosclerosis in patients with known or suspected coronary artery disease (CAD). 1-10 MSCT CAG not only assesses the degree of stenosis in the coronary lumen, but also provides direct information regarding the nonobstructive atherosclerotic plaque burden and plaque morphology within the vessel wall. 11,12 Despite technological advances, MSCT CAG has important limitations, such as motion artifacts resulting from a high heart rate (HR). 13,14 Residual motion artifacts hamper attainment of excellent image quality, leading to a reduction in diagnostic accuracy in detecting significant CAD. In particular, imaging of patients with a high HR often renders the coronary segments unassessable and coronary artery images are frequently affected by motion artifacts. 2,15 The -blockers are often given orally before MSCT CAG to reduce HR and stabilize image quality. Sixteen-slice MSCT CAG with -blocker premedication produces images of diagnostically acceptable quality, and the number of unassessable coronary segments because of motion artifacts is markedly reduced. 16 To ensure an optimal dose for reducing HR for image acquisition, intravenous administration of -blockers is reasonable because it allows better titration than oral administration; however, the effectiveness of intravenous -blocker administration has not been widely established.In this study we investigated the feasibility of intravenous injection of landiolol hydrochloride (Onoact, Ono Pharmaceutical Co, Osaka, Japan), a recently developed ultrashort-acting 1-selective agent, for MSCT CAG. Methods PopulationThe study included 145 patients with known or suspected CAD (chest pain complaints, elevated risk profile, or abnormal test results). All patients underwent MSCT CAG on admission to hospital. Inclusion criteria were typical chest pain with a stable condition, positive stress ECG tests, resting ECG abnormalities (suspected ischemic heart disease), and multiple coronary risk factors regardless of type (ie, typical or atypical) of chest pain (at least 2 risk Circ J 2008; 72: 1814 -1820 (Received April 4, 2008; revised manuscript received June 15, 2008; accepted June 26, 2008; released online September 29, 2008 Background The feasibility of using landiolol hydrochloride in multislice computed tomography (MSCT) coronary angiography (CAG) was investigated in the present study. Methods and ResultsLandiolol hydrochloride was continuously administered intravenously to 145 patients before starting MSCT CAG. Hemodynamic changes [blood pressure (BP), heart rate (HR)], adverse effects, image quality using a 5-point scale, and accuracy of detecting significant stenoses (≥50% reduction in lumen diameter) were evaluated. HR was significantly reduced during injection, and quickly recovered after cessation of administration, of landiolol hydrochloride. Neither significant changes in BP nor adverse effects occurred. Among visible segment...

A randomized, double-blind, placebo-controlled, phase II dose-finding study of the short acting β1-blocker, landiolol hydrochloride, in patients with suspected ischemic cardiac disease

“…Very few studies have reported the clinical use of the β 1 -receptor selective blocker landiolol hydrochloride [19, 20]. Isobe et al [19] reported the usefulness of the continuous injection of landiolol hydrochloride.…”

“…Isobe et al [19] reported the usefulness of the continuous injection of landiolol hydrochloride. However, the continuous injection method is complicated.…”

Predictors of worsening renal function after computed tomography coronary angiography: Assessed by cystatin C

“…0.75 mm, table feed of 3.0 mm/rotation, tube current of 400 mA, and tube voltage of 120 kV. 9 Measurements of oral fluid volume and renal function All patients were recommended to take as much oral fluid as possible. The amount of unrestricted oral fluid intake for 24 hours in each patient was calculated by nurses.…”

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

“…Landiolol hydrochloride has been a useful agent for improving the image quality of CCTA by 64- and 320-slice multi-detector CT (MDCT) as it was confirmed to reduce heart rate significantly and rapidly after intravenous injection [9–11]. Although there are some studies in which the efficacy, safety, or usefulness of β-blockers has been explored [11, 12], no study has examined the usefulness and safety of short-acting β-blockers at an approved dosage and with approved administration in CCTA by 16-slice MDCT.…”

“…However, due to the cost of 64-slice CT, most small- and medium-sized hospitals still have 16-slice CT. Sixteen-row CT is less expensive than the newer CTs and is still widely used in Japan. In addition, new low-dose algorithms for the reduction of radiation exposure are also available in CCTA with 16-slice CT, and the X-ray exposure dose of 16-slice MDCT is less than that of the 64-slice MDCT [13, 14]. It is possible to obtain an appropriate coronary image by 16-slice MDCT [15–22] if the patient’s heart rate during CCTA is properly controlled.…”