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Tandon R, Agakishiev D, Freese RL, Thompson J, Nijjar PS. Heart Rate Lowering for Coronary CTA with Ivabradine in End-Stage Liver Disease. Radiol Cardiothorac Imaging 2024; 6:e230402. [PMID: 38814188 PMCID: PMC11211931 DOI: 10.1148/ryct.230402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/28/2024] [Accepted: 04/23/2024] [Indexed: 05/31/2024]
Abstract
In a study of 282 patients with end-stage liver disease undergoing coronary CT angiography, administration of a single dose of ivabradine (up to 15 mg) was found to be safe and effective at heart rate lowering.
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Affiliation(s)
- Rishabh Tandon
- From the Department of Medicine, Cardiovascular Division, University
of Minnesota Medical Center, 420 Delaware St SE, MMC 508, Minneapolis, MN 55455
(R.T., P.S.N.); Department of Medicine (D.A.) and Department of Medicine,
Division of Gastroenterology, Hepatology and Nutrition (J.T.), University of
Minnesota Medical School, Minneapolis, Minn; and Clinical and Translational
Science Institute, Biostatistical Design and Analysis Center, University of
Minnesota, Minneapolis, Minn (R.L.F.)
| | - Dzhalal Agakishiev
- From the Department of Medicine, Cardiovascular Division, University
of Minnesota Medical Center, 420 Delaware St SE, MMC 508, Minneapolis, MN 55455
(R.T., P.S.N.); Department of Medicine (D.A.) and Department of Medicine,
Division of Gastroenterology, Hepatology and Nutrition (J.T.), University of
Minnesota Medical School, Minneapolis, Minn; and Clinical and Translational
Science Institute, Biostatistical Design and Analysis Center, University of
Minnesota, Minneapolis, Minn (R.L.F.)
| | - Rebecca L. Freese
- From the Department of Medicine, Cardiovascular Division, University
of Minnesota Medical Center, 420 Delaware St SE, MMC 508, Minneapolis, MN 55455
(R.T., P.S.N.); Department of Medicine (D.A.) and Department of Medicine,
Division of Gastroenterology, Hepatology and Nutrition (J.T.), University of
Minnesota Medical School, Minneapolis, Minn; and Clinical and Translational
Science Institute, Biostatistical Design and Analysis Center, University of
Minnesota, Minneapolis, Minn (R.L.F.)
| | - Julie Thompson
- From the Department of Medicine, Cardiovascular Division, University
of Minnesota Medical Center, 420 Delaware St SE, MMC 508, Minneapolis, MN 55455
(R.T., P.S.N.); Department of Medicine (D.A.) and Department of Medicine,
Division of Gastroenterology, Hepatology and Nutrition (J.T.), University of
Minnesota Medical School, Minneapolis, Minn; and Clinical and Translational
Science Institute, Biostatistical Design and Analysis Center, University of
Minnesota, Minneapolis, Minn (R.L.F.)
| | - Prabhjot S. Nijjar
- From the Department of Medicine, Cardiovascular Division, University
of Minnesota Medical Center, 420 Delaware St SE, MMC 508, Minneapolis, MN 55455
(R.T., P.S.N.); Department of Medicine (D.A.) and Department of Medicine,
Division of Gastroenterology, Hepatology and Nutrition (J.T.), University of
Minnesota Medical School, Minneapolis, Minn; and Clinical and Translational
Science Institute, Biostatistical Design and Analysis Center, University of
Minnesota, Minneapolis, Minn (R.L.F.)
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Agakishiev D, Arriola-Montenegro J, Tandon R, Markowitz J, Kazmirczak F, Nijjar PS. Heart rate lowering for coronary CTA with Ivabradine in atrial fibrillation. J Cardiovasc Comput Tomogr 2024; 18:109-110. [PMID: 37867126 DOI: 10.1016/j.jcct.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Dzhalal Agakishiev
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Rishabh Tandon
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jeremy Markowitz
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Felipe Kazmirczak
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Prabhjot S Nijjar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
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Maroules CD, Rybicki FJ, Ghoshhajra BB, Batlle JC, Branch K, Chinnaiyan K, Hamilton-Craig C, Hoffmann U, Litt H, Meyersohn N, Shaw LJ, Villines TC, Cury RC. 2022 use of coronary computed tomographic angiography for patients presenting with acute chest pain to the emergency department: An expert consensus document of the Society of cardiovascular computed tomography (SCCT): Endorsed by the American College of Radiology (ACR) and North American Society for cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr 2023; 17:146-163. [PMID: 36253281 DOI: 10.1016/j.jcct.2022.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/22/2022]
Abstract
Coronary computed tomography angiography (CTA) improves the quality of care for patients presenting with acute chest pain (ACP) to the emergency department (ED), particularly in patients with low to intermediate likelihood of acute coronary syndrome (ACS). The Society of Cardiovascular Computed Tomography Guidelines Committee was formed to develop recommendations for acquiring, interpreting, and reporting of coronary CTA to ensure appropriate, safe, and efficient use of this modality. Because of the increasing use of coronary CTA testing for the evaluation of ACP patients, the Committee has been charged with the development of the present document to assist physicians and technologists. These recommendations were produced as an educational tool for practitioners evaluating acute chest pain patients in the ED, in the interest of developing systematic standards of practice for coronary CTA based on the best available data or broad expert consensus. Due to the highly variable nature of medical care, approaches to patient selection, preparation, protocol selection, interpretation or reporting that differs from these guidelines may represent an appropriate variation based on a legitimate assessment of an individual patient's needs.
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Affiliation(s)
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brian B Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Juan C Batlle
- Department of Radiology, Baptist Cardiac and Vascular Institute, Miami, FL, USA
| | - Kelley Branch
- Department of Cardiology, University of Washington School of Medicine, Seattle, WA, USA
| | | | | | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Harold Litt
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nandini Meyersohn
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Todd C Villines
- Department of Cardiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ricardo C Cury
- Department of Radiology, Baptist Cardiac and Vascular Institute, Miami, FL, USA
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Effectiveness of point-of-care oral ivabradine for cardiac computed tomography. J Cardiovasc Comput Tomogr 2020; 15:226-231. [PMID: 33039320 DOI: 10.1016/j.jcct.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/29/2020] [Accepted: 09/15/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Coronary CT angiography (CCTA) is increasing seen as a first line investigation in patients with suspected coronary artery disease. Heart-rate control improves the image quality and diagnostic accuracy of CCTA. Typically, beta-blockers are administered to induce sinus bradycardia. Sinus bradycardia may also be induced by ivabradine. We hypothesized that in a real-world population ivabradine would be an effective alternative to metoprolol at heart rate lowering for CCTA. METHODS This was a retrospective analysis of consecutive patients who were exposed to an ivabradine-based (IB) versus a metoprolol-only (MO) protocol to achieve a target heart rate </ = 65bpm. Hemodynamic responses to both strategies were compared along with differences in cost and the time expired from medication administration to CCTA. RESULTS 5955 consecutive patients were included in the analysis: 3211 were imaged during an era of a metoprolol only strategy (MO) and 2744 CCTA following an ivabradine based (IB) strategy. 2676 patients had heart rates >65 and received heart-rate lowering medication: 1958 patients had MO, and 718 received IB protocol. Target heart rate of </ = 65bpm was achieved in 77% of MO and 89% of IB patients (p < 0.01). The time from initial medication administration to CCTA was longer in the IB versus MO patients (77 versus 48 min, p < 0.01). CONCLUSIONS Introduction of a novel single dose ivabradine-based protocol to control heart rate for CCTA was more successful in achieving target heart rate than a metoprolol-only strategy. The use of ivabradine however incurred a 1.6-fold increase in the time delay from medication administration and imaging compared to a metoprolol only protocol.
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Hellenbart EL, Griffin T, DiDomenico RJ. Beyond Heart Failure and Ischemic Heart Disease: A Scoping Review of Novel Uses of Ivabradine in Adults. Pharmacotherapy 2020; 40:544-564. [PMID: 32248556 DOI: 10.1002/phar.2391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/10/2020] [Accepted: 03/18/2020] [Indexed: 01/15/2023]
Abstract
Ivabradine lowers heart rate by inhibiting the hyperpolarization-activated current in pacemaker cells, and its use for the treatment of heart failure (HF) and ischemic heart disease (IHD) is well described. Ivabradine may be an attractive treatment option for other conditions for which a reduction in heart rate is desirable but less is known about its role in these settings. The primary objective was to perform a scoping review summarizing the literature evaluating novel uses for ivabradine other than HF and IHD in adults. PubMed and EMBASE were searched for articles for all dates through September 2019. Search strategies combined terms generic, commercial/trade, and international names for ivabradine. Manual search of references was also performed to identify additional articles. Studies were included if they were published in English, evaluated the efficacy of ivabradine for indications other than HF or IHD in patients aged 18 years or older, and the primary outcome included clinically relevant end points. Articles were screened first by title and abstract followed by full-text screening of the remaining articles. After removal of duplicates, 1807 records were screened for inclusion and 84 studies were included in this scoping review. Novel uses of ivabradine were reported for various tachyarrhythmias, valvular heart disease, premedication for coronary computed tomography angiography, perioperative risk reduction, sepsis with and without multi-organ dysfunction syndrome, cor pulmonale, reactive airway disease, and erectile dysfunction. This scoping review identified several potential novel uses for ivabradine in adults. This review may help to identify existing gaps where further research is needed to elucidate the role of ivabradine for indications beyond HF and IHD.
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Affiliation(s)
- Erika L Hellenbart
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois
| | - Tina Griffin
- Library of the Health Sciences-Chicago, University of Illinois at Chicago, Chicago, Illinois
| | - Robert J DiDomenico
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois.,Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, Illinois
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Muster V, Wallner M, Schmidt A, Kapl M, von Lewinski F, Rainer P, Reittner P, Tillich M, Brader P, Szolar DH, von Lewinski D. Heart rate-reducing therapy with add-on ivabradine and bisoprolol before coronary computed tomographic angiography in a fast-track ambulatory setting. J Int Med Res 2018; 46:2249-2257. [PMID: 29614895 PMCID: PMC6023055 DOI: 10.1177/0300060518761302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective This study was performed to determine whether add-on oral ivabradine in patients treated with beta blockers 1 hour before coronary computed tomographic angiography (CCTA) is effective in lowering the heart rate and thus improving CCTA quality. Methods In this single-center cohort study, the data of 294 patients referred for ambulant CCTA were retrospectively screened. Patients with an initial heart rate of ≥75 bpm (n = 112) were pretreated with either a combination of bisoprolol and ivabradine or with bisoprolol alone. Results During the scan, there was no difference in heart rate between the two groups Likewise, there was no significant difference in additionally administered intravenous bradycardic agents, the number of motion artifacts, or the radiation dose. Both drug regimens were tolerated well. Conclusion Additive oral ivabradine 1 hour before CCTA does not result in a further reduction of the heart rate. Consequently, neither movement artifacts nor radiation dose can be reduced. Therefore, pretreatment with ivabradine does not seem reasonably appropriate in an outpatient clinical setting with short patient contact.
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Affiliation(s)
- Viktoria Muster
- 1 Department of Cardiology, Medical University Graz, Austria
| | - Markus Wallner
- 1 Department of Cardiology, Medical University Graz, Austria.,3 Cardiovascular Research Center, Temple University School of Medicine, Philadelphia, PA, USA
| | | | - Martin Kapl
- 1 Department of Cardiology, Medical University Graz, Austria
| | | | - Peter Rainer
- 1 Department of Cardiology, Medical University Graz, Austria
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Role of the Funny Current Inhibitor Ivabradine in Cardiac Pharmacotherapy: A Systematic Review. Am J Ther 2018; 25:e247-e266. [DOI: 10.1097/mjt.0000000000000388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mander GTW. Computed tomography coronary angiography with heart rate control premedication: a best practice implementation project. ACTA ACUST UNITED AC 2017; 15:1968-1976. [PMID: 28708755 DOI: 10.11124/jbisrir-2016-003270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Computed tomography coronary angiography patient preparation with heart rate control premedication is employed in departments across Australia. However, the methods of administration vary widely between institutions and do not always follow best practice. OBJECTIVES This aim of the study was to identify and promote best practice in the administration of heart rate premedication in computed tomography coronary angiography at a regional hospital in Australia. METHODS The Joanna Briggs Institute have validated audit and feedback tools to assist with best practice implementation projects. This project used these tools, which involve three phases of activity - a pre-implementation audit, reflecting on results and implementing strategies to address non-compliance, and a post-implementation audit to assess the outcomes. RESULTS A baseline audit identified non-compliance in the majority of measured audit criteria. Following implementation of an institution-specific guideline and associated worksheet, improved compliance was shown across all audit criteria. CONCLUSIONS Following the development and implementation of institution-specific evidence-based resources relating to heart rate control in computed tomography coronary angiography, a high level of compliance consistent with best practice was achieved.
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Ghekiere O, Salgado R, Buls N, Leiner T, Mancini I, Vanhoenacker P, Dendale P, Nchimi A. Image quality in coronary CT angiography: challenges and technical solutions. Br J Radiol 2017; 90:20160567. [PMID: 28055253 PMCID: PMC5605061 DOI: 10.1259/bjr.20160567] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/13/2016] [Accepted: 01/03/2017] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Olivier Ghekiere
- Department of Radiology, Centre Hospitalier Chrétien (CHC), Liège, Belgium
- Department of Radiology, Jessa Ziekenhuis, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Rodrigo Salgado
- Department of Radiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Nico Buls
- Department of Radiology, UZ Brussel, Brussels, Belgium
| | - Tim Leiner
- Department of Radiology, Utrecht University Medical Center, Utrecht, Netherlands
| | - Isabelle Mancini
- Department of Radiology, Centre Hospitalier Chrétien (CHC), Liège, Belgium
| | | | - Paul Dendale
- Heart Center Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
| | - Alain Nchimi
- GIGA Cardiovascular Sciences, Liège University (ULg), Domaine Universitaire du Sart Tilman, Rue de l'hôpital, Liège, Belgium
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Heart-Rate Reduction With Adjusted-Dose Ivabradine in Patients Undergoing Coronary Computed Tomographic Angiography. J Comput Assist Tomogr 2017; 41:360-363. [DOI: 10.1097/rct.0000000000000556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abbara S, Blanke P, Maroules CD, Cheezum M, Choi AD, Han BK, Marwan M, Naoum C, Norgaard BL, Rubinshtein R, Schoenhagen P, Villines T, Leipsic J. SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: A report of the society of Cardiovascular Computed Tomography Guidelines Committee: Endorsed by the North American Society for Cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr 2016; 10:435-449. [PMID: 27780758 DOI: 10.1016/j.jcct.2016.10.002] [Citation(s) in RCA: 611] [Impact Index Per Article: 76.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/09/2016] [Indexed: 01/20/2023]
Abstract
In response to recent technological advancements in acquisition techniques as well as a growing body of evidence regarding the optimal performance of coronary computed tomography angiography (coronary CTA), the Society of Cardiovascular Computed Tomography Guidelines Committee has produced this update to its previously established 2009 "Guidelines for the Performance of Coronary CTA" (1). The purpose of this document is to provide standards meant to ensure reliable practice methods and quality outcomes based on the best available data in order to improve the diagnostic care of patients. Society of Cardiovascular Computed Tomography Guidelines for the Interpretation is published separately (2). The Society of Cardiovascular Computed Tomography Guidelines Committee ensures compliance with all existing standards for the declaration of conflict of interest by all authors and reviewers for the purpose ofclarity and transparency.
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Affiliation(s)
- Suhny Abbara
- University of Texas Southwestern Medical Center, Dallas, TX, United States.
| | - Philipp Blanke
- Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Michael Cheezum
- Cardiology Service Ft. Belvoir Community Hospital, Ft. Belvoir, VA, United States
| | - Andrew D Choi
- Division of Cardiology and Department of Radiology, The George Washington University School of Medicine, Washington DC, United States
| | - B Kelly Han
- Minneapolis Heart Institute and Children's Heart Clinic, Minneapolis, MN, United States
| | - Mohamed Marwan
- Cardiology Department, University Hospital, Erlangen, Germany
| | - Chris Naoum
- Concord Hospital, The University of Sydney, Sydney, Australia
| | - Bjarne L Norgaard
- Department of Cardiology B, Aarhus University Hospital-Skejby, Aarhus N, Denmark
| | - Ronen Rubinshtein
- Lady Davis Carmel Medical Center & Rappaport School of Medicine- Technion- IIT, Haifa, Israel
| | - Paul Schoenhagen
- Cardiovascular Imaging, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States
| | - Todd Villines
- Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Jonathon Leipsic
- Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
Ivabradine is a unique medication recently approved in the USA for the treatment of select heart failure patients. It was first approved for use in several countries around the world over a decade ago as an anti-anginal agent, with subsequent approval for use in heart failure patients. Since ivabradine has selective activity blocking the I f currents in the sinus node, it can reduce heart rate without appreciable effects on blood pressure. Given this heart-rate-specific effect, it has been investigated in many off-label indications as an alternative to traditional heart-rate-reducing medications such as beta blockers and calcium channel blockers. We conducted searches of PubMed and Google Scholar for ivabradine, heart failure, HFrEF, HFpEF, angina, coronary artery disease, inappropriate sinus tachycardia, postural orthostatic hypotension, coronary computed tomography angiography and atrial fibrillation. We reviewed and included studies, case reports, and case series published between 1980 and June 2016 if they provided information relevant to the practicing clinician. In many cases, larger clinical trials are needed to solidify the benefit of ivabradine, although studies indicate benefit in most therapeutic areas explored to date. The purpose of this paper is to review the current labeled and off-label uses of ivabradine, with a focus on clinical trial data.
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Cademartiri F, Garot J, Tendera M, Zamorano JL. Intravenous ivabradine for control of heart rate during coronary CT angiography: A randomized, double-blind, placebo-controlled trial. J Cardiovasc Comput Tomogr 2015; 9:286-94. [DOI: 10.1016/j.jcct.2015.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/22/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
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Pedersen C, Thomsen CF, Hosbond SE, Thomassen A, Mickley H, Diederichsen ACP. Coronary computed tomography angiography - tolerability of β-blockers and contrast media, and temporal changes in radiation dose. SCAND CARDIOVASC J 2014; 48:271-7. [PMID: 25100617 DOI: 10.3109/14017431.2014.951958] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the risk in administering β-blockers, contrast-induced nephropathy (CIN) and the trend in X-ray use, during coronary computed tomography angiography (CCTA). METHODS A total of 416 patients were referred for elective CCTA. To achieve a resting heart rate below 60 beats per minute, oral and/or intravenous β-blockers were administered. Using questionnaires, information on the adverse effects of β-blockers was collected from the patients. The levels of s-creatinine and estimated GFR (eGFR) were measured before and after contrast enhanced CCTA. Radiation exposure was compared with the exposure 3 years earlier. RESULTS There was no significant difference in the symptoms (dizziness, lipothymia and palpitations) between patients with and patients without β-blocker pretreatment. Compared to baseline values, the decrease in s-creatinine was not significant (75.2 vs. 74.6 μmol/L, p = 0.09), while the increase in eGFR was not significant (78 vs. 79 mL/min, p = 0.17). Also, subgroups of patients with hypertension, hypercholesterolemia, diabetes or pre-existing slight impairment in renal function did not develop CIN. The mean radiation exposure decreased from 17.5 to 6.7 mSv, p < 0.0001. CONCLUSIONS In terms of the side effects of β-blockers and contrast media, there were no short term complications to CCTA. Furthermore, the radiation dose has been dramatically diminished over the last three years.
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Affiliation(s)
- Charlotte Pedersen
- Department of Cardiology, Odense University Hospital , Odense C , Denmark
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