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Diltiazem as an alternative to beta-blocker in coronary artery computed tomography angiography

Carlos Eduardo Rochitte1, Guilherme Santana Antunes Azevedo, Afonso Akio Shiozaki

  • 1Instituto do Coração, HCFMUSP, São Paulo, SP, Brazil. rochitte@incor.usp.br

Arquivos Brasileiros De Cardiologia
|June 28, 2012
PubMed

Insights

Diltiazem effectively reduces heart rate (HR) for coronary computed tomography angiography (CTACor) when beta-blockers are contraindicated. This study found diltiazem comparable to metoprolol in HR reduction and safe for CTACor procedures.

Area of Science:

  • Cardiology
  • Radiology
  • Pharmacology

Background:

  • Optimal image quality in coronary computed tomography angiography (CTACor) necessitates heart rate (HR) reduction.
  • Calcium channel blockers are an understudied alternative for patients unable to take beta-blockers.

Purpose of the Study:

  • To compare the efficacy of metoprolol and diltiazem in reducing HR and RR variability during CTACor.
  • To evaluate the safety and effectiveness of diltiazem as an alternative to beta-blockers for HR control in CTACor.

Main Methods:

  • A prospective, randomized, open-label study involving 50 patients undergoing CTACor with HR > 70 bpm.
  • Patients received either intravenous metoprolol or diltiazem, with HR and blood pressure monitored at multiple time points.
  • The target HR for both groups was ≤ 60 bpm.

Main Results:

  • Metoprolol showed a higher absolute HR reduction compared to diltiazem.
  • Percentage HR reduction was significantly greater with metoprolol at 1 and 3 minutes, but not at 5 minutes.
  • Diltiazem demonstrated lower RR variability during acquisition and was associated with one transient atrioventricular block.

Conclusions:

  • Diltiazem is an effective and safe alternative for reducing HR in CTACor when beta-blockers are contraindicated.
  • Diltiazem offers a viable option for improving CTACor image quality in specific patient populations.
Abstract

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