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Single dose ivabradine versus intravenous metoprolol for heart rate reduction before coronary computed tomography angiography (CCTA) in patients receiving long-term calcium channel-blocker therapy.
Acta Radiol. 2014 Jul; 55(6):676-81.AR

Abstract

BACKGROUND

In patients with contraindication for beta-blockers who are also under long-term calcium channel-blocker therapy for any reason, ivabradine may be used as an alternative treatment to achieve the target heart rate.

PURPOSE

To assess whether single dose oral ivabradine in patients referred for coronary computed tomography angiography (CCTA) is safe and can significantly decrease heart rate compared to intravenous (i.v.) metoprolol in patients receiving long-term calcium channel-blocker therapy.

MATERIAL AND METHODS

One-hundred and twenty patients who were under calcium channel-blocker therapy referred for CCTA were randomized to premedication with single dose (15 mg) ivabradine (n = 63) or i.v. metoprolol (5-10 mg) (n = 62). Hearth rate (HR) was assessed at admission (HR1), prescan (HR2), and during CCTA scan (HR3) for all patients. Blood pressure (BP) was measured before medication (BP1) and immediately before CCTA scan (BP2).

RESULTS

Although the HR averages of two groups were not significantly different before medication (HRIv1 = 80 ± 7 bpm vs. HRβ1 = 81 ± 7 bpm; P = 0.42), significant HR reduction was observed in the ivabradine group (HRIv3 = 62 ± 7 bpm) when compared to the metoprolol group (HRβ3 = 66 ± 6 bpm; P = 0.001). Decreases in HR forivabradine (18 ± 6 bpm) was significantly higher than for metoprolol (15 ± 4 bpm; P = 0.003) without relevant side-effects. Ivabradine showed no significant effect on either systolic BP or diastolic BP (siBPIv1, 139 ± 10; siBPIv2, 138 ± 10; P = 0.260; diBPIv1, 81 ± 7; diBPIv2, 81 ± 6; P = 0.59). Nevertheless, metoprolol group demonstrated significant reduction in both SiBP and DiBP (siBPβ1, 136 ± 11; siBPβ2 130 ± 11; P < 0.001; diBPβ1, 81 ± 6; diBPβ2, 78 ± 6; P < 0.001).

CONCLUSION

Single dose ivabradine is safe and significantly more effective than i.v. metoprolol in decreasing HR in patients under calcium channel-blocker therapy.

Authors+Show Affiliations

Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Istanbul, Turkey.Maltepe University School of Medicine, Radiology Department, Istanbul, Turkey mmatasoy@gmail.com.Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Istanbul, Turkey.Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Istanbul, Turkey.Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Istanbul, Turkey.Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Radiology Department, Istanbul, Turkey.Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Istanbul, Turkey.Dr. Siyami Ersek Thoracic & Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Istanbul, Turkey.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

24052362

Citation

Celik, O, et al. "Single Dose Ivabradine Versus Intravenous Metoprolol for Heart Rate Reduction Before Coronary Computed Tomography Angiography (CCTA) in Patients Receiving Long-term Calcium Channel-blocker Therapy." Acta Radiologica (Stockholm, Sweden : 1987), vol. 55, no. 6, 2014, pp. 676-81.
Celik O, Atasoy MM, Ertürk M, et al. Single dose ivabradine versus intravenous metoprolol for heart rate reduction before coronary computed tomography angiography (CCTA) in patients receiving long-term calcium channel-blocker therapy. Acta Radiol. 2014;55(6):676-81.
Celik, O., Atasoy, M. M., Ertürk, M., Yalçın, A. A., Aksu, H. U., Diker, M., Aktürk, I. F., & Atasoy, I. (2014). Single dose ivabradine versus intravenous metoprolol for heart rate reduction before coronary computed tomography angiography (CCTA) in patients receiving long-term calcium channel-blocker therapy. Acta Radiologica (Stockholm, Sweden : 1987), 55(6), 676-81. https://doi.org/10.1177/0284185113505276
Celik O, et al. Single Dose Ivabradine Versus Intravenous Metoprolol for Heart Rate Reduction Before Coronary Computed Tomography Angiography (CCTA) in Patients Receiving Long-term Calcium Channel-blocker Therapy. Acta Radiol. 2014;55(6):676-81. PubMed PMID: 24052362.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Single dose ivabradine versus intravenous metoprolol for heart rate reduction before coronary computed tomography angiography (CCTA) in patients receiving long-term calcium channel-blocker therapy. AU - Celik,O, AU - Atasoy,M M, AU - Ertürk,M, AU - Yalçın,A A, AU - Aksu,H U, AU - Diker,M, AU - Aktürk,I F, AU - Atasoy,I, Y1 - 2013/09/19/ PY - 2013/9/21/entrez PY - 2013/9/21/pubmed PY - 2015/4/11/medline KW - Ivabradine KW - calcium channelblocker KW - coronary CT angiography KW - heart rate SP - 676 EP - 81 JF - Acta radiologica (Stockholm, Sweden : 1987) JO - Acta Radiol VL - 55 IS - 6 N2 - BACKGROUND: In patients with contraindication for beta-blockers who are also under long-term calcium channel-blocker therapy for any reason, ivabradine may be used as an alternative treatment to achieve the target heart rate. PURPOSE: To assess whether single dose oral ivabradine in patients referred for coronary computed tomography angiography (CCTA) is safe and can significantly decrease heart rate compared to intravenous (i.v.) metoprolol in patients receiving long-term calcium channel-blocker therapy. MATERIAL AND METHODS: One-hundred and twenty patients who were under calcium channel-blocker therapy referred for CCTA were randomized to premedication with single dose (15 mg) ivabradine (n = 63) or i.v. metoprolol (5-10 mg) (n = 62). Hearth rate (HR) was assessed at admission (HR1), prescan (HR2), and during CCTA scan (HR3) for all patients. Blood pressure (BP) was measured before medication (BP1) and immediately before CCTA scan (BP2). RESULTS: Although the HR averages of two groups were not significantly different before medication (HRIv1 = 80 ± 7 bpm vs. HRβ1 = 81 ± 7 bpm; P = 0.42), significant HR reduction was observed in the ivabradine group (HRIv3 = 62 ± 7 bpm) when compared to the metoprolol group (HRβ3 = 66 ± 6 bpm; P = 0.001). Decreases in HR forivabradine (18 ± 6 bpm) was significantly higher than for metoprolol (15 ± 4 bpm; P = 0.003) without relevant side-effects. Ivabradine showed no significant effect on either systolic BP or diastolic BP (siBPIv1, 139 ± 10; siBPIv2, 138 ± 10; P = 0.260; diBPIv1, 81 ± 7; diBPIv2, 81 ± 6; P = 0.59). Nevertheless, metoprolol group demonstrated significant reduction in both SiBP and DiBP (siBPβ1, 136 ± 11; siBPβ2 130 ± 11; P < 0.001; diBPβ1, 81 ± 6; diBPβ2, 78 ± 6; P < 0.001). CONCLUSION: Single dose ivabradine is safe and significantly more effective than i.v. metoprolol in decreasing HR in patients under calcium channel-blocker therapy. SN - 1600-0455 UR - https://www.unboundmedicine.com/medline/citation/24052362/Single_dose_ivabradine_versus_intravenous_metoprolol_for_heart_rate_reduction_before_coronary_computed_tomography_angiography__CCTA__in_patients_receiving_long_term_calcium_channel_blocker_therapy_ L2 - http://journals.sagepub.com/doi/full/10.1177/0284185113505276?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -