“In-house” pharmacological management for computed tomography coronary angiography: heart rate reduction, timing and safety of different drugs used during patient preparation

Abstract

We retrospectively evaluated the effect, timing and safety of different pharmacological strategies during 64-slice CT coronary angiography (CT-CA). From the institutional database of CT-CAwe enrolled 560 consecutive patients with suspected coronary artery disease. The type of drug preparation (group 1 = no treatment; group 2 = oral metoprolol; group 3 = other; group 4 = intravenous (IV) atenolol; group 5 = IV atenolol + nitrates; NR = non-responders), timing, and adverse effects were recorded. Heart rate (HR) during different preparation phases was recorded. Four adverse effects were recorded, none of which was attributable to pharmacological treatment. In all groups, except group 1, the HR on arrival was significantly reduced by the pharmacological treatment (p<0.01). Group 4 showed the best (-16±8 bpm) HR reduction. There was no significant effect on HR due to nitrates (p = 0.49), while a slight increase due to contrast material was noted (p<0.05). Average time required for preparation was 44±25min. Groups 4 and 5 showed the most effective timing (8±9 min and 8±8 min, respectively; p<0.01). Pharmacological preparation in patients undergoing CT-CA is safe and effective. Best results in terms of HR reduction and fast preparation are obtained with IV administration of beta-blockers.

Bailout intravenous esmolol for heart rate control in cardiac computed tomography angiography

“…This has led to the use of several alternate regimens including intravenous metoprolol, other beta-blockers such as atenolol, ivabradine, or calcium channel blockers. 14,15 Nevertheless intravenous metoprolol, the most commonly used parenteral beta-blocker, has demonstrated limited efficacy in lowering HR. Ivabradine has been suggested as an alternative to betablockers.…”

Acceptance of noninvasive computed tomography coronary angiography: for a patient-friendly medicine

“…The heart rate parameter was influenced by the pharmacological preparation (beta-blockers, benzodiazepines); however, diazepam was given before the administration of the EMAS test in order to equalise the heart rate-state anxiety readings. A proper and effective pharmacological preparation of patients represents an early essential step to perform CTCA [34,35]. Image quality assessment was only performed on a per-patient basis to maintain patient unity in relation to individual psyche.…”

Safety and efficacy of oral ivabradine as a heart rate-reducing agent in patients undergoing CT coronary angiography

“…An essential part of performing a successful CT CA examination is to optimise the patient's heart rate using b-blockers to limit motion artefacts in the coronary arteries. However, despite the routine use of b-blockers prior to CTCA studies, it is not uncommon to have patients with heart rates persistently above the target range of 65 bpm, despite using oral as well as iv b-blockers [9][10][11]15].…”

“…those with baseline blood pressure ,100-110 mmHg, severe left ventricular dysfunction, peripheral vascular disease or severe obstructive airway disease). Moreover, despite the routine use of b-blockers prior to CTCA studies, it is not uncommon to have patients with heart rates persistently above the target range of 65 bpm [9][10][11].…”