Comparison of different strategies of ivabradine premedication for heart rate reduction before coronary computed tomography angiography |
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| Affiliation: | 1. Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey;2. Department of Radiology, Maltepe University School of Medicine, Istanbul, Turkey;3. Department of Radiology, Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey;4. Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey;5. Department of Cardiology, Dr. Siyami Ersek Thoracic & Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey;1. Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy;2. Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy;1. Department of Radiology, Royal Brompton Hospital, UK;2. National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, UK;3. Department of Cardiology, Royal Brompton Hospital, UK;1. Division of Cardiovascular Medicine, The Howard Gilman Institute for Heart Valve Disease and the Schiavone Institute for Cardiovascular Translational Research, State University of New York Downstate Medical Center, New York, New York;2. Klinik für Innere Medizin III, Universitätskliniken des Saarlandes, Homburg, Saar, Germany;3. Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom;4. Department of Cardiology, Pierre et Marie Curie Paris VI University, La Pitié-Salpétrière Hospital, Paris, France;5. Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy;6. Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden;1. Department of Radiology, Cardiac CT/MR Unit, Rouen University Hospital, 1 rue de Germont, 76031 Rouen, France;2. Inserm U1096, Rouen, France;3. University of Rouen, Institute for Research and Innovation in Biomedicine, Rouen, France;4. Department of Cardiology, Rouen University Hospital, Rouen, France;1. Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA;2. Division of Internal Medicine, Virginia Commonwealth University Medical Center-Medical College of Virginia, 1200 E Broad Street, Richmond, VA 23298, USA;3. Division of Cardiology, St. Luke''s–Roosevelt Hospital Center, Columbia College of Physicians and Surgeons, New York, NY, USA;4. Division of Cardiology, Danbury Hospital, Danbury, CT, USA;5. Division of Cardiology, Emory University, Atlanta, GA, USA;6. Princeton Longevity Center, Princeton, NJ, USA;7. Tennessee Heart and Vascular Center, Hendersonville, TN, USA;8. Cedars–Sinai Medical Center and the Cedars–Sinai Heart Institute, Los Angeles, CA, USA;9. Division of Cardiology, Mazankowski Alberta Heart Institute, Edmonton, AB, Canada;10. Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA;11. Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor–UCLA, Torrance, CA, USA |
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| Abstract: | ObjectiveThe aim of this study was to assess the effectiveness and safety of different strategies of ivabradine therapy by comparing the effects on heart rate (HR), blood pressure (BP), and image quality of coronary CT angiography (CTA).MethodsA total of 192 consecutive patients were randomly assigned to 3 groups of oral premedication with ivabradine 15 mg (single dose), 10 mg (single dose), and 5 mg twice daily for 5 days, prospectively. Patients using HR-lowering drugs and patients with β-blockade contraindication were excluded. The target HR was 65 beats/min. In addition 5 to 10 mg of intravenous metoprolol was administered to the patients at the CT unit, if required. The systolic and diastolic blood BP values and the HRs were recorded. Image quality was assessed for 8 of 15 coronary segments with a 4-point grading scale. Results were compared with the Kruskal-Wallis test, one-way ANOVA, and χ2 test.ResultsReductions in mean HR after the treatment were 18 ± 6, 14 ± 4, and 17 ± 7 beats/min for groups 1, 2, and 3, respectively. With the total additional therapies, 81.3%, 67.2%, and 84.3% of the patients achieved HR < 65 beats/min in groups 1, 2, and 3, respectively. The mean BP values before coronary CTA were not significantly changed except for patients in group 2. Unacceptable (score 0) image quality was obtained in only 4.5%, 10.2%, and 4.2% of all the coronary segments, in groups 1, 2, and 3, respectively.ConclusionsOur study indicates that coronary CTA with premedication with oral ivabradine in all 3 strategies is safe and effective in reducing HR, in particular with a β-blockade combination. All 3 ivabradine regimes may be an alternative strategy for HR lowering in patients undergoing coronary CTA. Ivabradine 15 mg (single dose) and ivabradine 5 mg twice daily for 5 days are superior to the ivabradine 10-mg single-dose regime for HR lowering without adjunctive intravenous β-blocker usage. |
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| Keywords: | Ivabradine Coronary CT Safety Multidetector CT Different strategies Single dose versus multiple dose |
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