Diltiazem as an alternative to beta-blocker in coronary artery computed tomography angiography.
BACKGROUND
Reducing heart rate (HR) in CT angiography of the coronary arteries (CTACor) is critical to image quality. The effectiveness of calcium channel blockers as alternatives for patients with contraindications to beta-blockers has not been established.


OBJECTIVE
To compare the efficacy in the reduction of HR and RR variability of metoprolol and diltiazem in CTACor.


METHODS
Prospective, randomized, open study that included patients with clinical indication of CTACor in sinus rhythm with HR > 70 bpm and no use of agents that could interfere with HR. Fifty patients were randomized to the groups: metoprolol IV 5-15 mg or up to HR ≤ 60 bpm (M), and diltiazem IV 0.25 to 0.60 mg/kg or up to HR ≤ 60 bpm (D). Blood pressure (BP) and HR were measured at baseline, 1 minute, 3 minutes and 5 minutes after the agents, at the acquisition and after CTACor.


RESULTS
HR reduction in absolute values was higher in group M than in group D (1, 3, 5 min, acquisition and post-test). The percentage reduction of HR was significantly higher in group M only 1 min and 3 min after the start of the agents. There was no difference in 5 min at acquisition and after examination. The percentage RR variability in group D was lower than that in group M during acquisition (RR variability/mean HR of acquisition). A single case of AVB, 2:1 Mobitz I occurred, which was spontaneously reverted (group D).


CONCLUSIONS
We conclude that diltiazem is an effective and safe alternative to beta-blockers in the reduction of HR when performing computed tomography angiography of coronary arteries.
Instituto do Coração, HCFMUSP, São Paulo, SP, Brazil. rochitte@incor.usp.br
Carlos Eduardo
CE
Rochitte
Guilherme Santana Antunes
GS
Azevedo
Afonso Akio
AA
Shiozaki
Clerio Francisco
CF
Azevedo
Roberto
R
Kalil Filho
D058671:Adrenergic beta-1 Receptor Antagonists; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000494:pharmacology*; D000075202:Contraindications; D017023:Coronary Angiography / Q000379:methods*; D004110:Diltiazem / Q000494:pharmacology*; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008790:Metoprolol; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
D058671:Adrenergic beta-1 Receptor Antagonists; D002121:Calcium Channel Blockers; D004110:Diltiazem; D008790:Metoprolol