Safety and efficacy of patient preparation with intravenous esmolol before 64-slice computed tomography coronary angiography

Değertekin, Muzaffer; Gemici, Gökmen; Kaya, Zafer; Bayrak, Fatih; Güneysu, Tahsin; Sevinc, Deniz; Mutlu, Bülent; Aytaclar, Semih

doi:10.1097/mca.0b013e3282f27c20

Cited by 34 publications

(22 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition, the rapid action and short half-life of esmolol make it an attractive drug in this setting. Similarly to data reported by Degertekin et al, 10 in our study bolus esmolol produced HR below 65 bpm in 63% (82/130) of patients. Thus, the introduction of bailout intravenous esmolol enabled 95% of the entire cohort to be imaged with HR below 65 bpm.…”

Section: Discussionsupporting

confidence: 71%

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

Rosa

Ramos

Marques

et al. 2016

Revista Portuguesa de Cardiologia (English Edition)

View full text Add to dashboard Cite

Objective: To evaluate the efficacy and safety of a heart rate (HR) reduction protocol using intravenous esmolol as bailout for failed oral metoprolol regimens in patients undergoing coronary computed tomography angiography (CCTA) with 64-slice multidetector computed tomography (64-MDCT). Methods: Patients who underwent cardiac 64-MDCT in a single institution between 2011 and 2014 were analyzed. Those with HR above 60 beats per minute (bpm) on presentation received oral metoprolol (50-200 mg) at least one hour before CCTA. Intravenous esmolol 1-2 mg/kg was administered as a bolus whenever HR remained over 65 bpm just before imaging. The primary efficacy endpoint was HR <65 bpm during CCTA. The primary safety endpoint was symptomatic hypotension or bradycardia up to hospital discharge. Results: During the study period CCTA was performed in 947 cases. In 86% of these, oral metoprolol was the only medication required to successfully reduce HR <60 bpm. Esmolol was used in the remaining 130 patients (14%). For esmolol-treated patients mean baseline and acquisition HR were 74±14 bpm and 63±9 bpm, respectively (p<0.001). The target HR of <65 bpm was achieved in 82 of the 130 esmolol-treated patients (63%). Considering the whole population, esmolol use led to a significant increase in the primary efficacy endpoint from 86% to 95% (p<0.001). Esmolol also resulted in a statistically, but not clinically, significant reduction in systolic blood pressure (144±22 to 115±17 mmHg; p<0.001). The combined primary safety endpoint was only observed in two (1.5%) patients. Conclusion: Despite optimal use of oral beta-blockers, 14% of patients needed intravenous esmolol for HR control. The pre-medication combination of oral metoprolol and on-demand administration of intravenous esmolol was safe and effective and enabled 95% of patients to be imaged with HR below 65 bpm. Document downloaded from http://www.elsevier.es, day 21/09/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from http://www.elsevier.es, day 21/09/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Conclusão: Apesar da utilização sistemática de betabloqueante oral, 14% dos casos necessitaram de esmolol endovenoso para controlo adequado de FC. Pré-medicação combinada de metoprolol oral e esmolol endovenoso quando necessária foi segura e eficaz, e permitiu que 95% dos doentes apresentassem FC <65 bpm no momento da aquisição de imagem. S. Aguiar Rosa et al. PALAVRAS-CHAVE

show abstract

Section: Discussionsupporting

confidence: 71%

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

Rosa

Ramos

Marques

et al. 2016

Revista Portuguesa de Cardiologia (English Edition)

View full text Add to dashboard Cite

show abstract

“…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].…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

mentioning

confidence: 99%

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

Adile

Kapoor²,

Jain³

et al. 2012

The British Journal of Radiology

View full text Add to dashboard Cite

Objective: To investigate the role of oral ivabradine as a heart rate reducing agent in patients undergoing CT coronary angiography (CTCA). Despite the routine use of bblockers prior to CTCA studies, it is not uncommon to have patients with heart rates persistently above the target range of 65 bpm. Ivabradine is a selective inhibitor of the I f current, which primarily contributes to sinus node pacemaker activity, and has no significant direct cardiovascular effects such as reduction of blood pressure, cardiac contractility or impairment of cardiac conduction. Methods: We investigated 100 consecutive patients who had been referred for CTCA for the evaluation of suspected coronary artery disease (CAD). Patients were randomised to receive either of the following two pre-medication protocols: oral metorprolol or oral ivabradine. Results: Ivabradine was significantly more effective than metorprolol in lowering the heart rate; the mean percentage reduction in heart rate with ivabradine vs metorpolol was 23.89+6.95% vs 15.20+4.50%, respectively (p50.0001). Metoprolol significantly lowered both systolic and diastolic blood pressure while ivabradine did not. The requirement of additional doses to achieve a target heart rate of ,65 beats per min was also significantly more frequent with metoprolol. Conclusion: Ivabradine is a potentially attractive alternative to currently used drugs for reduction of heart rate in patients undergoing CTCA.

show abstract

“…Kalp döngüsünde diyastolik fazın uzaması rekonstrüksiyon kalitesini artırdığı için kalp hızının 65/dk'nın altında sabit olması ve eğer bu değerin üzerindeyse kısa etkili β-blokör (ör: esmolol, metoprolol) ile hızın yavaşlatılması önerilmektedir. Yine koroner vazodilatasyon için nitrogliserin kullanılmaktadır (11). Acil servis hastalarında her iki grup ilacın rutin kullanımı düşük kan basıncı ve β-blokör kontrendikasyonu durumlarında sorun teşkil edebilir.…”

Section: çOk Kesitli Koroner Bilgisayarlı Tomografiunclassified

A New Approach To Chest Pain in the Emergency Room: “Triple Rule-Out CT

Öztürk¹,

Güneysel²,

Yesil³

et al. 2012

JAEM

View full text Add to dashboard Cite

Safety and efficacy of patient preparation with intravenous esmolol before 64-slice computed tomography coronary angiography

Abstract: Intravenous esmolol is safe and effective to reach the optimum heart rate in patients assigned for MSCT.

Cited by 34 publications

References 23 publications

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

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

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

A New Approach To Chest Pain in the Emergency Room: “Triple Rule-Out CT

Contact Info

Product

Resources

About