Prospective Clinical Trial Comparing IV Esmolol to IV Metoprolol in CT Coronary Angiography: Effect on Hemodynamic,
Leena Robinson Vimala1,2, Diego Andre Eifer1, Yasser Karimzad1
1Joint Department of Medical Imaging, Toronto General Hospital, Ontario, Canada.
Insights
Intravenous esmolol and metoprolol effectively achieve target heart rates for coronary CT angiography. Esmolol offers faster hemodynamic recovery, making it a favorable alternative despite higher initial cost.
Area of Science:
- Cardiology
- Radiology
- Pharmacology
Background:
- Intravenous (IV) esmolol is an alternative to IV metoprolol for coronary computed tomography angiography (CCTA).
- Esmolol's shorter half-life may reduce the risk of prolonged hypotension compared to metoprolol.
- This study prospectively compares IV esmolol and IV metoprolol for CCTA effectiveness.
Purpose of the Study:
- To compare the effectiveness of IV esmolol versus IV metoprolol in achieving a target heart rate (HR) of 60 beats per minute (bpm) during CCTA.
- To evaluate and compare hemodynamic response, image quality, radiation dose, and cost between the two agents.
- To assess the safety and efficacy of beta-blockers in CCTA procedures.
Main Methods:
- Prospective randomized controlled trial involving 28 CCTA patients.
- Blinded, 1:1 matching of patients to receive either IV esmolol or IV metoprolol.
- Serial hemodynamic measurements and independent image quality scoring by two cardiac radiologists.
Main Results:
- Both IV esmolol and IV metoprolol successfully achieved the target HR of 60 bpm.
- IV esmolol demonstrated a significantly less profound and shorter duration of systolic blood pressure reduction compared to IV metoprolol.
- No significant differences were observed in HR at image acquisition, radiation dose, or image quality.
Conclusions:
- Both IV esmolol and IV metoprolol are effective for achieving target HR during CCTA.
- Patients receiving IV esmolol exhibited significantly faster recovery of HR and blood pressure.
- IV esmolol may be a preferred agent due to improved hemodynamic recovery, despite comparable overall costs.
Background:
Intravenous [IV] esmolol, an alternative to IV metoprolol for coronary computed tomography angiography [CCTA], has shorter half-life that decreases the risk of prolonged hypotension. The primary aim was to prospectively compare IV esmolol alone to IV metoprolol alone for effectiveness in achieving heart rate [HR] of 60 beats per minute[bpm] during CCTA. The secondary aim was to compare hemodynamic response, image quality, radiation dose and cost.
Materials And Methods:
Institutional Review Board approved prospective randomized study of 28 CCTA patients medicated in a 1:1 blinded match with IV esmolol or IV metoprolol to achieve HR of 60 bpm. Serial hemodynamic response was measured at 6 specified times. Two cardiac radiologists independently scored the image quality.
Results:
Both IV esmolol and IV metoprolol achieved the target HR. IV esmolol resulted in significantly less profound and shorter duration of reduction in systolic blood pressure [BP] than IV metoprolol with a difference of -10, -14 and -9 mm Hg compared to -20, -26 and -25 mmHg at 2, 15 & 30 min respectively. No significant difference in HR at image acquisition, exposure window, radiation dose and image quality. Although IV esmolol was expensive, the overall cost of care was comparable to IV metoprolol due to shortened post CCTA observation period consequent to faster restoration of hemodynamic status.
Conclusion:
Comparison of IV esmolol and IV metoprolol demonstrate that both are effective in achieving the target HR but significantly faster recovery of HR and BP in patients who receive IV esmolol was found.
Related Concept Videos
01:28Imaging Studies for Cardiovascular System V: CT
01:30Acute Coronary Syndrome III: Diagnostic Studies