Heart rate control with oral ivabradine in computed tomography coronary angiography: a randomized comparison of 7.5 mg vs 5 mg regimen.
BACKGROUND
Heart rate (HR) reduction is essential to achieve optimal image quality and diagnostic accuracy with computed tomography coronary angiography (CTCA). Administration of oral ivabradine seems to be more effective than beta-blockade in reducing HR in patients referred for CTCA.


METHODS
Two-hundred-fifty-nine consecutive patients referred for CTCA were prospectively enrolled. Patients not receiving beta-blocker at baseline (group 1) and those with beta-blocker therapy (group 2) were enrolled in the study. Each group was randomized into 3 parallel arms with 1:1:1 allocation. Patients who did not receive beta-blocker at baseline: underwent CTCA without beta blocker (n=49), and received ivabradine 5mg (n=48), or 7.5mg ivabradine (n=48). Patients with beta-blocker therapy: continued with the prior beta-blocker without any dose modification (n=38), and received ivabradine 5mg (n=38), or ivabradine 7.5mg (n=38).


RESULTS
HR and blood pressure were assessed at admission (T0), immediately before CTCA (T1) and during CTCA (T2). Administration of ivabradine 7.5mg significantly reduced mean relative HR at T1 and T2 (p<0.01), the rate of patients not achieving target HR at T1 (p<0.001) and T2 (p<0.01), and the percentage of patients needing additional IV beta-blockade prior to CTCA (p<0.01). Results remained statistically significant even after correction for age, gender, ejection fraction, risk factors and HR at T0, in a multivariable analysis.


CONCLUSIONS
Ivabradine 7.5mg is more effective than ivabradine 5mg in increasing the rate of patients at target HR in patients referred for CTCA.
Cardiology Department, University of Foggia, Ospedali Riuniti Hospital, Foggia, Italy. andrea.guaricci@gmail.com
Andrea Igoren
AI
Guaricci
Erica
E
Maffei
Natale D
ND
Brunetti
Deodata
D
Montrone
Luigi
L
Di Biase
Carlo
C
Tedeschi
Giovanni
G
Gentile
Luca
L
Macarini
Massimo
M
Midiri
Filippo
F
Cademartiri
Matteo
M
Di Biase
D000284:Administration, Oral; D000368:Aged; D001552:Benzazepines / Q000008:administration & dosage*; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006339:Heart Rate / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D000077550:Ivabradine; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
D001552:Benzazepines; D000077550:Ivabradine