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Failed heart rate control with oral metoprolol prior to coronary CT angiography: effect of additional intravenous metoprolol on heart rate, image quality and radiation dose

  • Laura Jiménez-Juan
  • Elsie T. Nguyen
  • Bernd J. Wintersperger
  • Hadas Moshonov
  • Andrew M. Crean
  • Djeven P. Deva
  • Narinder S. Paul
  • Felipe S. Torres
Original Paper

Abstract

The purpose of this study was to evaluate the effect of intravenous (IV) metoprolol after a suboptimal heart rate (HR) response to oral metoprolol (75–150 mg) on HR control, image quality (IQ) and radiation dose during coronary CTA using 320-MDCT. Fifty-three consecutive patients who failed to achieve a target HR of < 60 bpm after an oral dose of metoprolol and required supplementary IV metoprolol (5–20 mg) prior to coronary CTA were evaluated. Patients with HR < 60 bpm during image acquisition were defined as responders (R) and those with HR ≥ 60 bpm as non-responders (NR). Two observers assessed IQ using a 3-point scale (1–2, diagnostic and 3, non-diagnostic). Effective dose (ED) was estimated using dose-length product and a 0.014 mSV/mGy.cm conversion factor. Baseline characteristics and HR on arrival were similar in the two groups. 58 % of patients didn’t achieve the target HR after receiving IV metoprolol (NR). R had a significantly higher HR reduction after oral (mean HR 63.9 ± 4.5 bpm vs. 69.6 ± 5.6 bpm) (p < 0.005) and IV (mean HR 55.4 ± 3.9 bpm vs. 67.4 ± 5.3 bpm) (p < 0.005) doses of metoprolol. Studies from NR showed a significantly higher ED in comparison to R (8.0 ± 2.9 vs. 6.1 ± 2.2 mSv) (p = 0.016) and a significantly higher proportion of non-diagnostic coronary segments (9.2 vs. 2.5 %) (p < 0.001). 58 % of patients who do not achieve a HR of <60 bpm prior to coronary CTA with oral fail to respond to additional IV metoprolol and have studies with higher radiation dose and worse image quality.

Keywords

Heart rate Beta-blocker Coronary artery disease Image quality Radiation dose 320 MDCT 

Notes

Conflict of interest

Narinder S. Paul has received research support from Toshiba Medical Systems.

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Copyright information

© Springer Science+Business Media, B.V. 2012

Authors and Affiliations

  • Laura Jiménez-Juan
    • 1
  • Elsie T. Nguyen
    • 1
  • Bernd J. Wintersperger
    • 1
  • Hadas Moshonov
    • 2
    • 3
  • Andrew M. Crean
    • 1
    • 4
  • Djeven P. Deva
    • 1
  • Narinder S. Paul
    • 1
  • Felipe S. Torres
    • 5
    • 6
  1. 1.Cardiothoracic Division, Department of Medical Imaging, Toronto General HospitalUniversity Health NetworkTorontoCanada
  2. 2.Joint Department of Medical Imaging, Mount Sinai HospitalUniversity Health NetworkTorontoCanada
  3. 3.Women’s College HospitalUniversity Health NetworkTorontoCanada
  4. 4.Department of Cardiology, Toronto General HospitalUniversity Health NetworkTorontoCanada
  5. 5.Cardiothoracic Division, Department of Medical ImagingSunnybrook Health Sciences CentreTorontoCanada
  6. 6.School of MedicineUniversidade Federal do Rio Grande do SulPorto AlegreBrazil

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