Document Detail


Evaluation of contraindications and efficacy of oral Beta blockade before computed tomographic coronary angiography.
MedLine Citation:
PMID:  20211317     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Multidetector computed tomographic coronary angiography (CTA) image quality is inversely related to the heart rate (HR). As a result beta-blocking medication is routinely administered before investigation. In the present study, the use, contraindications, and efficacy of prescan beta blockade with regard to HR reduction and CTA image quality were assessed. In 537 patients referred for CTA, the baseline HR and blood pressure were measured on arrival, and contraindications for beta blockade were noted. Unless contraindicated, a single dose of metoprolol was administered orally 1 hour before data acquisition in patients with a HR of > or =65 beats/min according to a predefined medication protocol. After 1 hour, the HR was remeasured. A total of 283 patients (53%) had a HR of > or =65 beats/min. In this group, beta blockade was contraindicated in 46 patients (16%). Metoprolol was administered to the remaining 237 patients. However, 26 patients (11%) received suboptimal (lower dose than prescribed by protocol) beta blockade because of contraindications. Of the 211 patients receiving optimal beta blockade, 57 (27%) did not achieve the target HR. Of the patients with contraindications to beta blockade, 43 (60%) did not achieve the target HR. Compared to patients with optimal HR control, those receiving no or suboptimal beta blockade because of contraindications had significantly fewer examinations of good image quality (40% vs 74%, p <0.001), and significantly more examinations of poor image quality (20% vs 6%, p <0.001). In conclusion, most patients require HR reduction before CTA. Contraindications to beta blockade are present in a substantial proportion of patients. This results in suboptimal HR control and image quality, indicating the need for alternative approaches for HR reduction.
Authors:
Fleur R de Graaf; Joanne D Schuijf; Joëlla E van Velzen; Lucia J Kroft; Albert de Roos; Allard Sieders; J Wouter Jukema; Martin J Schalij; Ernst E van der Wall; Jeroen J Bax
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of cardiology     Volume:  105     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-09     Completed Date:  2010-03-29     Revised Date:  2010-07-20    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  767-72     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
Affiliation:
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Adrenergic beta-Antagonists / administration & dosage*,  contraindications
Blood Pressure / drug effects
Coronary Angiography*
Female
Heart Rate / drug effects
Humans
Male
Metoprolol / administration & dosage*,  contraindications
Middle Aged
Premedication*
Tomography, X-Ray Computed*
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 37350-58-6/Metoprolol
Comments/Corrections
Comment In:
Radiologe. 2010 Jul;50(7):588   [PMID:  20596855 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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