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Andre F, Fortner P, Emami M, Seitz S, Brado M, Gückel F, Sokiranski R, Sommer A, Frey N, Görich J, Buss SJ. Factors influencing the safety of outpatient coronary CT angiography: a clinical registry study. BMJ Open 2022; 12:e058304. [PMID: 35940836 PMCID: PMC9364403 DOI: 10.1136/bmjopen-2021-058304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Since the safety of coronary CT angiography (CTA) is of great importance, especially with regard to widening indications and increasing morbidity, the aim of this study was to assess influencing factors. METHODS Patients undergoing coronary CTA in a third-generation dual-source CT in a radiological centre were included in a clinical registry. Up to 20 mg metoprolol was administered intravenously to attain a heart rate ≤65/min. Glyceryl trinitrate (GTN) was administered in doses of 0.8 mg and 0.4 mg. Blood pressure was measured before the administration and after the CTA. RESULTS Out of 5500 consecutive patients (3194 men, 62.3 (54.9-70.0) years), adverse events occurred in 68 patients (1.2%) with mild anaphylactoid reactions (0.4%), vasovagal symptoms (0.3%) and extravasation (0.3%) being most frequent. Anti-allergic drugs were given in 17 patients, atropine in 3 patients and volume in 1 patient. Drug administration resulted in a significant mean arterial pressure decline (96.0 (88.3-106.0) vs 108.7 (99.7-117.3) mmHg; p<0.001). Patients who suffered systolic blood pressure drops >20 mmHg or >40 mmHg were older (66.5 (58.6-73.3) vs 60.5 (53.6-68.3) years; 70.2 (63.3-76.5) vs 62.1 (54.7-69.6) years), more often male (65.1% vs 54.4%; 68.9% vs 57.3%) and had higher Agatston score equivalents (83.0 (2.0-432.0) vs 15.0 (0.0-172.0); 163.0 (16.3-830.8) vs 25.0 (0.0-220.0); all p<0.001). GTN dose reduction lowered the fraction of patients suffering from blood pressure drops >20 mmHg or >40 mmHg from 34.5% to 27.4% and from 6.1% to 3.5% (both p<0.001), respectively. The proportion of coronary segments with impaired image quality did not differ significantly. CONCLUSIONS Coronary CTA with intravenous beta-blocker administration is a safe procedure in an outpatient setting as adverse events are rare and mostly mild. Reduced GTN doses can further improve safety by lowering the rate of significant blood pressure drops, which occurred especially in elderly men with increased plaque burden. TRIAL REGISTRATION NUMBER NCT03815123.
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Affiliation(s)
- Florian Andre
- Department of Cardiology, Angiology and Pneumology, Heidelberg University, Heidelberg, Germany
- MVZ-DRZ Sinsheim Eberbach Erbach Walldorf Heidelberg, Heidelberg, Germany
| | - Philipp Fortner
- MVZ-DRZ Sinsheim Eberbach Erbach Walldorf Heidelberg, Heidelberg, Germany
| | - Mostafa Emami
- MVZ-DRZ Sinsheim Eberbach Erbach Walldorf Heidelberg, Heidelberg, Germany
| | - Sebastian Seitz
- MVZ-DRZ Sinsheim Eberbach Erbach Walldorf Heidelberg, Heidelberg, Germany
| | - Matthias Brado
- MVZ-DRZ Sinsheim Eberbach Erbach Walldorf Heidelberg, Heidelberg, Germany
| | - Friedemann Gückel
- MVZ-DRZ Sinsheim Eberbach Erbach Walldorf Heidelberg, Heidelberg, Germany
| | - Roman Sokiranski
- MVZ-DRZ Sinsheim Eberbach Erbach Walldorf Heidelberg, Heidelberg, Germany
| | - André Sommer
- MVZ-DRZ Sinsheim Eberbach Erbach Walldorf Heidelberg, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, Heidelberg University, Heidelberg, Germany
| | - Johannes Görich
- MVZ-DRZ Sinsheim Eberbach Erbach Walldorf Heidelberg, Heidelberg, Germany
| | - Sebastian J Buss
- MVZ-DRZ Sinsheim Eberbach Erbach Walldorf Heidelberg, Heidelberg, Germany
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Vimala LR, Eifer DA, Karimzad Y, Paul NS. Prospective Clinical Trial Comparing IV Esmolol to IV Metoprolol in CT Coronary Angiography: Effect on Hemodynamic, Technical Parameters and Cost. Can Assoc Radiol J 2021; 73:240-248. [PMID: 34293933 DOI: 10.1177/08465371211023947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Leena Robinson Vimala
- Joint Department of Medical Imaging, Toronto General Hospital, Ontario, Canada.,Department of Medical Imaging, London Health Sciences Centre, University Hospital, London, United Kingdom
| | - Diego Andre Eifer
- Joint Department of Medical Imaging, Toronto General Hospital, Ontario, Canada
| | - Yasser Karimzad
- Joint Department of Medical Imaging, Toronto General Hospital, Ontario, Canada
| | - Narinder S Paul
- Joint Department of Medical Imaging, Toronto General Hospital, Ontario, Canada.,Department of Medical Imaging, London Health Sciences Centre, University Hospital, London, United Kingdom
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Androshchuk V, Sabharwal N, St Noble V, Kelion A. Speeding up beta-blockade prior to coronary CT angiography: can we predict the dose of intravenous metoprolol required to achieve target heart rate in a given patient? Clin Radiol 2020; 76:236.e21-236.e25. [PMID: 33298312 DOI: 10.1016/j.crad.2020.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/30/2020] [Indexed: 10/22/2022]
Abstract
AIM To evaluate the use and safety of intravenous (IV) metoprolol in a cohort of patients undergoing coronary computed tomographic angiography (CCTA) at a university hospital, and in particular, to establish if the minimum dose required to achieve the target heart rate (HR) in a given patient can be predicted from the baseline HR. MATERIALS AND METHODS Patients undergoing CCTA at a tertiary centre between January 2015 and May 2018, with baseline HR ≥60 bpm requiring IV metoprolol, were identified retrospectively from the database. Patients with a contraindication to beta-blockade or an indication for CCTA other than coronary disease were excluded. HR at baseline and at the time of scanning were recorded, together with the total dose of IV metoprolol administered. RESULTS Of 625 patients identified, 330 (52.8%) achieved HR ≤60 with IV metoprolol. Patients who achieved target HR had lower baseline HR. They received a lower radiation exposure due to tight prospective gating and a lower tube voltage. The lower quartile dose of metoprolol administered was 5 mg for patients with baseline HR <65 beats per minute (bpm), but 10 mg for HR 65-74 bpm, and ≥20 mg for higher HRs. There were no cases of symptomatic bradycardia/hypotension. CONCLUSION Patients with a resting HR of ≥60 bpm can reasonably be given an initial minimum dose of 5-20 mg metoprolol IV before CCTA, with additional doses as required.
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Affiliation(s)
- V Androshchuk
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK.
| | - N Sabharwal
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - V St Noble
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - A Kelion
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK
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EANM procedural guidelines for PET/CT quantitative myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 2020; 48:1040-1069. [PMID: 33135093 PMCID: PMC7603916 DOI: 10.1007/s00259-020-05046-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/17/2020] [Indexed: 12/19/2022]
Abstract
The use of cardiac PET, and in particular of quantitative myocardial perfusion PET, has been growing during the last years, because scanners are becoming widely available and because several studies have convincingly demonstrated the advantages of this imaging approach. Therefore, there is a need of determining the procedural modalities for performing high-quality studies and obtaining from this demanding technique the most in terms of both measurement reliability and clinical data. Although the field is rapidly evolving, with progresses in hardware and software, and the near perspective of new tracers, the EANM Cardiovascular Committee found it reasonable and useful to expose in an updated text the state of the art of quantitative myocardial perfusion PET, in order to establish an effective use of this modality and to help implementing it on a wider basis. Together with the many steps necessary for the correct execution of quantitative measurements, the importance of a multiparametric approach and of a comprehensive and clinically useful report have been stressed.
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Boehm I, Morelli J, Nairz K, Silva Hasembank Keller P, Heverhagen JT. Beta blockers and intravenous roentgen contrast materials: Which risks do exist? Eur J Intern Med 2016; 35:e17-e18. [PMID: 27531627 DOI: 10.1016/j.ejim.2016.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Ingrid Boehm
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland; Radiology Laboratory, Department of Clinical Research, University of Bern, Bern, Switzerland.
| | | | - Knud Nairz
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | | | - Johannes T Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland; Radiology Laboratory, Department of Clinical Research, University of Bern, Bern, Switzerland
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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: 629] [Impact Index Per Article: 78.6] [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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Maurovich-Horvat P, Károlyi M, Horváth T, Szilveszter B, Bartykowszki A, Jermendy ÁL, Panajotu A, Celeng C, Suhai FI, Major GP, Csobay-Novák C, Hüttl K, Merkely B. Esmolol is noninferior to metoprolol in achieving a target heart rate of 65 beats/min in patients referred to coronary CT angiography: A randomized controlled clinical trial. J Cardiovasc Comput Tomogr 2015; 9:139-45. [DOI: 10.1016/j.jcct.2015.02.001] [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: 09/02/2014] [Revised: 01/24/2015] [Accepted: 02/07/2015] [Indexed: 10/24/2022]
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