Pre-treatment with a sinus node blockade, ivabradine, before coronary CT angiography: a retrospective audit
1Department of cardiology, Odense University Hospital, Svendborg, Denmark. Jess.lambrechtsen@ouh.regionsyddanmark.dk
Insights
A 1-day home regimen of ivabradine significantly lowered heart rate (HR) and reduced the need for beta-blockers (BB) before coronary CT angiography (CTA). This simple pre-treatment improves patient preparation for cardiac imaging.
Area of Science:
- Cardiology
- Medical Imaging
- Pharmacology
Background:
- Coronary computed tomography angiography (CTA) requires a controlled heart rate (HR) for optimal image quality.
- Intravenous beta-blockers (BB) are commonly used to achieve target HR but can cause side effects.
- A simple, effective pre-treatment strategy is needed to reduce BB reliance.
Purpose of the Study:
- To assess the efficacy of a 1-day home-based ivabradine regimen.
- To determine if ivabradine reduces pre-procedural HR and the need for intravenous BBs before coronary CTA.
- To compare different ivabradine dosages for HR control.
Main Methods:
- Patients were divided into three groups: no pre-treatment (Group 1), 5 mg ivabradine twice daily (Group 2), and 7.5 mg ivabradine twice daily (Group 3).
- Heart rates were measured before coronary CTA.
- Intravenous BB usage and achievement of target HR were recorded and compared across groups.
Main Results:
- Mean HR before CTA was significantly lower in all ivabradine groups (64.9-63.2 bpm) compared to the no-treatment group (70 bpm).
- The use of intravenous BBs was significantly reduced in Group 2 (5.1 mg) versus Group 1 (9 mg).
- Target HR of 65 bpm was achieved more frequently with increasing ivabradine dosage (37% in Group 1, 47% in Group 2, 61% in Group 3).
Conclusions:
- A 1-day home administration of ivabradine effectively lowers HR before coronary CTA.
- This pre-treatment strategy significantly decreases the requirement for intravenous BBs.
- Ivabradine offers a promising alternative for optimizing patient preparation for cardiac CTA.
Aim:
To evaluate whether a simple pre-treatment regimen of sinus node inhibition by ivabradine taken at home for only 1 day resulted in a lower pre-scanning heart rate (HR) and reduced the need for intravenous beta-blockers (BB) prior to coronary computed tomography angiography (CTA).
Materials And Methods:
The pre-treatment regimen for coronary CTA changed from using no medication at home (group 1 patients) to the use of 5 mg ivabradine twice a day (group 2 patients), to using 7.5 mg ivabradine twice a day (group 3 patients). The target HR was the same for groups 1 and 2, but lower for group 3. HRs and the use of intravenous BB before coronary CTA was performed were compared between the study groups.
Results:
The mean HR immediately before the planned CTA procedure was significantly lower throughout groups 1-3 with values of 70 ± 12.9, 64.9 ± 9.8, and 63.2 ± 10.6 beats/min in groups 1, 2, and 3, respectively (p < 0.001). This resulted in a significantly diminished use of intravenous BB in group 2 (mean 5.1 ± 5.8 mg) compared to group 1 (mean 9 ± 7.6 mg; p = 0.002). The target HR of 65 beats/min was achieved in 37%, 47%, and 61% of groups 1, 2, and 3, respectively (p < 0.0001).
Conclusion:
In conclusion, the administration of ivabradine tablets at home for only 1 day to patients scheduled for coronary CTA resulted in a significantly lower in-clinic HR and a significantly lower mean use of intravenous BB.
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