Efficacy of pre-scan beta-blockade and impact of heart rate on image quality in patients undergoing coronary multidetector computed tomography angiography

Shapiro, Michael D.; Peña, Antonio J.; Nichols, John H.; Worrell, Stewart S.; Bamberg, Fabian; Dannemann, Nina; Abbara, Suhny; Cury, Ricardo C.; Brady, Thomas J.; Hoffmann, Udo

doi:10.1016/j.ejrad.2007.05.006

Cited by 74 publications

(34 citation statements)

References 23 publications

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“…However, the efficacy of beta-blocker administration to consequently achieve the targeted HR remains a subject of discussion. 29 In patients with relative or absolute contraindications to beta-blocker administration, calcium-channel blockers and ivabradine are known alternatives. 30 Finally, the administration of 0.4-mg sublingual nitroglycerin prior to coronary CTA increases the coronary diameter for improved image quality, especially for smaller branches.…”

Section: Patient Selection and Preparationmentioning

confidence: 99%

Image quality in coronary CT angiography: challenges and technical solutions

Ghekiere

Salgado

Buls

et al. 2017

BJR

114

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Multidetector CT angiography (CTA) has become a widely accepted examination for non-invasive evaluation of the heart and coronary arteries. Despite its ongoing success and worldwide clinical implementation, it remains an often-challenging procedure in which image quality, and hence diagnostic value, is determined by both technical and patient-related factors. Thorough knowledge of these factors is important to obtain high-quality examinations. In this review, we discuss several key elements that may adversely affect coronary CTA image quality as well as potential measures that can be taken to mitigate their impact. In addition, several recent vendor-specific advances and future directions to improve image quality are discussed. INTRODUCTIONThe high negative-predictive value of coronary CT angiography (CTA) makes it a suitable tool for excluding significant coronary artery disease.1 Coronary CTA is technically complex and places a greater emphasis on scanning technologies than any other type of CT examination. Indeed, coronary arteries both have small calibre and varying degrees of motion during the cardiac cycle.2 Image quality can be degraded by many patient-and technique-related factors. Image artefacts are causes for misinterpretation, making the diagnostic accuracy of coronary CTA to a great extent dependent on their recognition and operator-awareness.2,3 Potential problems related to these artefacts include insufficient tissue contrast, limited spatial and temporal resolution and inadequate volume coverage. The aim of this review was to discuss these technical issues, important recent vendorspecific solutions as well as future directions.

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Section: Patient Selection and Preparationmentioning

confidence: 99%

Image quality in coronary CT angiography: challenges and technical solutions

Ghekiere

Salgado

Buls

et al. 2017

BJR

114

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

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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.

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“…All this contributes to the poorer quality of diagnostic images and explains the need for alternative strategies and drugs 23,24 . The following are contraindications to beta-blockers, selective or not: presence of advanced atrioventricular block, hypotension, asthma, Chronic Obstructive Pulmonary Disease (COPD) and clinical Table 4 16 .…”

Section: Discussionmentioning

confidence: 99%