Single dose ivabradine versus intravenous metoprolol for heart rate reduction before coronary computed tomography angiography (CCTA) in patients receiving long-term calcium channel-blocker therapy.
BACKGROUND
In patients with contraindication for beta-blockers who are also under long-term calcium channel-blocker therapy for any reason, ivabradine may be used as an alternative treatment to achieve the target heart rate.


OBJECTIVE
To assess whether single dose oral ivabradine in patients referred for coronary computed tomography angiography (CCTA) is safe and can significantly decrease heart rate compared to intravenous (i.v.) metoprolol in patients receiving long-term calcium channel-blocker therapy.


METHODS
One-hundred and twenty patients who were under calcium channel-blocker therapy referred for CCTA were randomized to premedication with single dose (15 mg) ivabradine (n = 63) or i.v. metoprolol (5-10 mg) (n = 62). Hearth rate (HR) was assessed at admission (HR1), prescan (HR2), and during CCTA scan (HR3) for all patients. Blood pressure (BP) was measured before medication (BP1) and immediately before CCTA scan (BP2).


RESULTS
Although the HR averages of two groups were not significantly different before medication (HRIv1 = 80 ± 7 bpm vs. HRβ1 = 81 ± 7 bpm; P = 0.42), significant HR reduction was observed in the ivabradine group (HRIv3 = 62 ± 7 bpm) when compared to the metoprolol group (HRβ3 = 66 ± 6 bpm; P = 0.001). Decreases in HR forivabradine (18 ± 6 bpm) was significantly higher than for metoprolol (15 ± 4 bpm; P = 0.003) without relevant side-effects. Ivabradine showed no significant effect on either systolic BP or diastolic BP (siBPIv1, 139 ± 10; siBPIv2, 138 ± 10; P = 0.260; diBPIv1, 81 ± 7; diBPIv2, 81 ± 6; P = 0.59). Nevertheless, metoprolol group demonstrated significant reduction in both SiBP and DiBP (siBPβ1, 136 ± 11; siBPβ2 130 ± 11; P < 0.001; diBPβ1, 81 ± 6; diBPβ2, 78 ± 6; P < 0.001).


CONCLUSIONS
Single dose ivabradine is safe and significantly more effective than i.v. metoprolol in decreasing HR in patients under calcium channel-blocker therapy.
Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Istanbul, Turkey.
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Celik
Maltepe University School of Medicine, Radiology Department, Istanbul, Turkey mmatasoy@gmail.com.
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Atasoy
Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Istanbul, Turkey.
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Ertürk
Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Istanbul, Turkey.
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Yalçın
Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Istanbul, Turkey.
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Aksu
Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Radiology Department, Istanbul, Turkey.
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Diker
Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Istanbul, Turkey.
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Aktürk
Dr. Siyami Ersek Thoracic & Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Istanbul, Turkey.
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Atasoy
D000284:Administration, Oral; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage; D001552:Benzazepines / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000008:administration & dosage*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D004305:Dose-Response Relationship, Drug; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D007275:Injections, Intravenous; D000077550:Ivabradine; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage*; D008875:Middle Aged; D011292:Premedication / Q000379:methods*; D011446:Prospective Studies; D013995:Time
D000889:Anti-Arrhythmia Agents; D001552:Benzazepines; D002121:Calcium Channel Blockers; D000077550:Ivabradine; D008790:Metoprolol
Ivabradine; calcium channelblocker; coronary CT angiography; heart rate