Heart rate reduction during Coronary computed tomography angiography: A randomized comparison of metoprolol alone vs metoprolol plus ivabradine
Keywords:
Coronary CT angiography, ivabradine, metoprololAbstract
Background: Coronary CT angiography (CCTA) is a first line investigation in patients with suspected coronary artery disease. Heart rate control using beta blockers and ivabradine improves the image quality and diagnostic accuracy of CCTA. Objective: To establish the efficacy of Metoprolol vs Metoprolol plus Ivabradine one hour before CCTA for the heart rate reduction and thus improving CCTA quality. Methods: Patients undergoing CCTA meeting inclusion criteria were randomized into three groups. Arm I was administered metoprolol 200 mg., Arm II was administered metoprolol 200 mg. plus ivabradine 2.5 mg. while Arm III was administered metoprolol 200 mg plus ivabradine 5 mg. one hour before scan. Blood pressure, heart rate before, during and after scan were recorded. Results: A total of 72 patients were included in the study, 24 patients in each group. Target heart rate of ≤ 65 bpm was achieved in 95.8% of Arm III. Heart rate reduction in Arm I was 17.63±6.48, in Arm II was 20.38±6.66 and in Arm III was 22.21±7.06 (p=0.06). CCTA image quality with Arm III had high diagnostically coronary segments imaging compared to Arm I and II. Conclusion: Metoprolol and ivabradine 5 mg. are an established effective heart rate reducing agent and good image quality in patients undergoing CCTA.
Downloads
References
Madonna R, Balistreri CR, De Rosa S, et al. Impact of sex differences and diabetes on coronary atherosclerosis and ischemic heart disease. J Clin Med. 2019;8(1). doi:10.3390/jcm8010098
Min JK, Dunning A, Lin FY, et al. Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease. J Am Coll Cardiol. 2011;58(8):849-860. doi:10.1016/j.jacc.2011.02.074
Budoff MJ, Dowe D, Jollis JG, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol. 2008;52(21):1724-1732. doi:10.1016/j.jacc.2008.07.031
Vanhoenacker PK, Heijenbrok-Kal MH, Van Heste R, et al. Diagnostic performance of multidetector CT angiography for assessment of coronary artery disease: meta-analysis. Radiology. 2007;244(2):419-428. doi:10.1148/radiol.2442061218
Groothuis JGJ, Beek AM, Meijerink MR, et al. Positive predictive value of computed tomography coronary angiography in clinical practice. Int J Cardiol. 2012;156(3):315-319. doi:10.1016/j.ijcard.2010.11.008
Abbara S, Blanke P, Maroules CD, et al. 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 he North American Society for Cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr. 2016;10(6):435-449. doi:10.1016/j.jcct.2016.10.002
Groen JM, Greuter MJW, van Ooijen PMA, Willems TP, Oudkerk M. Initial results on visualization of coronary artery stents at multiple heart rates on a moving heart phantom using 64-MDCT. J Comput Assist Tomogr. 2006;30(5):812-817. doi:10.1097/01.rct.0000226398.43235.6f
Hausleiter J, Meyer T, Hermann F, et al. Estimated radiation dose associated with cardiac CT angiography. JAMA. 2009;301(5):500-507. doi:10.1001/jama.2009.54
Hendriksen LC, Omes-Smit G, Koch BCP, Ikram MA, Stricker BH, Visser LE. Sex-based difference in the effect of metoprolol on heart rate and bradycardia in a population-based setting. J Pers Med. 2022;12(6):870. doi:10.3390/jpm12060870
Benfield P, Clissold SP, Brogden RN. Metoprolol. An updated review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy, in hypertension, ischaemic heart disease and related cardiovascular disorders. Drugs. 1986;31(5):376-429.
Ferrari R. The ivabradine journey: Table 1. Eur Heart J Suppl. 2015;17(suppl G):G1-G9. doi:10.1093/eurheartj/suv059
Koruth JS, Lala A, Pinney S, Reddy VY, Dukkipati SR. The clinical use of ivabradine. J Am Coll Cardiol. 2017;70(14):1777-1784. doi:10.1016/j.jacc.2017.08.038
Simko F, Baka T. Ivabradine and blood pressure reduction: Underlying pleiotropic mechanisms and clinical implications. Front Cardiovasc Med. 2021;8:607998. doi:10.3389/fcvm.2021.607998
Ansari MM, Ali SS, Mumtaz MH, Ahmad F, Naeem A, Ahmad H. The efficacy of ivabradine alone, metoprolol alone and combination of ivabradine and metoprolol in reducing heart rate among patients undergoing computed tomography coronary angiography. J Med. Published online 2018.
Qiu S, Shi S, Ping H, Zhou S, Wang H, Yang B. Efficacy of ivabradine versus -blockers for heart rate reduction during computed tomography coronary angiography: A meta-analysis of randomized controlled trials. Cardiology. 2016;135(3):133-140. doi:10.1159/000447236
Guaricci AI, Maffei E, Brunetti ND, et al. Heart rate control with oral ivabradine in computed tomography coronary angiography: a randomized comparison of 7.5 mg vs 5 mg regimen. Int J Cardiol. 2013;168(1):362-368. doi:10.1016/j.ijcard.2012.09.041
Tuyyab F, Khadim R, Farhan S, Siddique AH, Munir F, Iqbal T. EFFICACY OF IVABRADINE, METOPROLOL ALONE VS IVABRADINE PLUS METOPROLOL (COMBINATION) FOR HEART RATE REDUCTION AND HEART RATE VARIABILITY DURING COMPUTED TOMOGRAPHY CORONARY ANGIOGRAPHY: A RANDOMIZED CONTROLLED TRIAL. Pak Armed Forces Med J. 2018;68:S1-4.
Pichler P, Pichler-Cetin E, Vertesich M, et al. Ivabradine versus metoprolol for heart rate reduction before coronary computed tomography angiography. Am J Cardiol. 2012;109(2):169-173. doi:10.1016/j.amjcard.2011.08.025
Adile KK, Kapoor A, Jain SK, et al. Safety and efficacy of oral ivabradine as a heart rate-reducing agent in patients undergoing CT coronary angiography. Br J Radiol. 2012;85(1016):e424-8. doi:10.1259/bjr/22102914
Muster V, Wallner M, Schmidt A, et al. 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(6):2249-2257. doi:10.1177/0300060518761302
Patel N, Sakhi P, Jain S, Jain S, Patel K, Soni K. Ivabradine: A novel drug to control heart of patients undergoing CT coronary angiography. Scholars J Appl Med Sci. 2014;2:171-175
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Chulabhorn Royal Academy
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright and Disclaimer
Articles published in this journal are the copyright of Chulabhorn Royal Academy.
The opinions expressed in each article are those of the individual authors and do not necessarily reflect the views of Chulabhorn Royal Academy or any other faculty members of the Academy. The authors are fully responsible for all content in their respective articles. In the event of any errors or inaccuracies, the responsibility lies solely with the individual authors.
