Emel Celiker Guler1, Yeung Yam2, Kateleen Jia3, Huda El Mais4, Alomgir Hossain5, Benjamin J W Chow6, Gary R Small7. 1. University of Ottawa Heart Institute, Department of Medicine (Cardiology and Nuclear Medicine), Canada. Electronic address: ecelikerguler@ottawaheart.ca. 2. University of Ottawa Heart Institute, Department of Medicine (Cardiology and Nuclear Medicine), Canada. Electronic address: yyam@ottawaheart.ca. 3. University of Ottawa Heart Institute, Department of Medicine (Cardiology and Nuclear Medicine), Canada. Electronic address: kjia@ottawaheart.ca. 4. University of Ottawa Heart Institute, Department of Medicine (Cardiology and Nuclear Medicine), Canada. Electronic address: helmais@ottawaheart.ca. 5. University of Ottawa Heart Institute, Cardiovascular Research Methods Centre, Canada. Electronic address: alhossain@ottawaheart.ca. 6. University of Ottawa Heart Institute, Department of Medicine (Cardiology and Nuclear Medicine), Canada; University of Ottawa, Department of Radiology, Canada. Electronic address: Bchow@ottawaheart.ca. 7. University of Ottawa Heart Institute, Department of Medicine (Cardiology and Nuclear Medicine), Canada. Electronic address: gsmall@ottawaheart.ca.
Abstract
BACKGROUND: Coronary CT angiography (CCTA) is increasing seen as a first line investigation in patients with suspected coronary artery disease. Heart-rate control improves the image quality and diagnostic accuracy of CCTA. Typically, beta-blockers are administered to induce sinus bradycardia. Sinus bradycardia may also be induced by ivabradine. We hypothesized that in a real-world population ivabradine would be an effective alternative to metoprolol at heart rate lowering for CCTA. METHODS: This was a retrospective analysis of consecutive patients who were exposed to an ivabradine-based (IB) versus a metoprolol-only (MO) protocol to achieve a target heart rate </ = 65bpm. Hemodynamic responses to both strategies were compared along with differences in cost and the time expired from medication administration to CCTA. RESULTS: 5955 consecutive patients were included in the analysis: 3211 were imaged during an era of a metoprolol only strategy (MO) and 2744 CCTA following an ivabradine based (IB) strategy. 2676 patients had heart rates >65 and received heart-rate lowering medication: 1958 patients had MO, and 718 received IB protocol. Target heart rate of </ = 65bpm was achieved in 77% of MO and 89% of IB patients (p < 0.01). The time from initial medication administration to CCTA was longer in the IB versus MO patients (77 versus 48 min, p < 0.01). CONCLUSIONS: Introduction of a novel single dose ivabradine-based protocol to control heart rate for CCTA was more successful in achieving target heart rate than a metoprolol-only strategy. The use of ivabradine however incurred a 1.6-fold increase in the time delay from medication administration and imaging compared to a metoprolol only protocol.
BACKGROUND: Coronary CT angiography (CCTA) is increasing seen as a first line investigation in patients with suspected coronary artery disease. Heart-rate control improves the image quality and diagnostic accuracy of CCTA. Typically, beta-blockers are administered to induce sinus bradycardia. Sinus bradycardia may also be induced by ivabradine. We hypothesized that in a real-world population ivabradine would be an effective alternative to metoprolol at heart rate lowering for CCTA. METHODS: This was a retrospective analysis of consecutive patients who were exposed to an ivabradine-based (IB) versus a metoprolol-only (MO) protocol to achieve a target heart rate </ = 65bpm. Hemodynamic responses to both strategies were compared along with differences in cost and the time expired from medication administration to CCTA. RESULTS: 5955 consecutive patients were included in the analysis: 3211 were imaged during an era of a metoprolol only strategy (MO) and 2744 CCTA following an ivabradine based (IB) strategy. 2676 patients had heart rates >65 and received heart-rate lowering medication: 1958 patients had MO, and 718 received IB protocol. Target heart rate of </ = 65bpm was achieved in 77% of MO and 89% of IB patients (p < 0.01). The time from initial medication administration to CCTA was longer in the IB versus MO patients (77 versus 48 min, p < 0.01). CONCLUSIONS: Introduction of a novel single dose ivabradine-based protocol to control heart rate for CCTA was more successful in achieving target heart rate than a metoprolol-only strategy. The use of ivabradine however incurred a 1.6-fold increase in the time delay from medication administration and imaging compared to a metoprolol only protocol.
Authors: Rami M Abazid; Yasmine T Sallam; Jonathan G Romsa; James C Warrington; Cigdem Akincioglu; Sabe De; Nikolaos Tzemos; William C Vezina Journal: Eur J Hybrid Imaging Date: 2022-02-01