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Bailout Intravenous Esmolol for Heart Rate Control in Cardiac Computed Tomography Angiography

2016-12Journal article Open access
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dc.contributor.authorRosa, S
dc.contributor.authorRamos, R
dc.contributor.authorMarques, H
dc.contributor.authorSantos, R
dc.contributor.authorLeal, C
dc.contributor.authorCasado, H
dc.contributor.authorSaraiva, M
dc.contributor.authorFigueiredo, L
dc.contributor.authorCruz Ferreira, R
dc.date.accessioned2017-11-06T12:25:08Z
dc.date.available2017-11-06T12:25:08Z
dc.date.issued2016-12
dc.description.abstractOBJECTIVE: To evaluate the efficacy and safety of a heart rate (HR) reduction protocol using intravenous esmolol as bailout for failed oral metoprolol regimens in patients undergoing coronary computed tomography angiography (CCTA) with 64-slice multidetector computed tomography (64-MDCT). METHODS: Patients who underwent cardiac 64-MDCT in a single institution between 2011 and 2014 were analyzed. Those with HR above 60 beats per minute (bpm) on presentation received oral metoprolol (50-200 mg) at least one hour before CCTA. Intravenous esmolol 1-2 mg/kg was administered as a bolus whenever HR remained over 65 bpm just before imaging. The primary efficacy endpoint was HR <65 bpm during CCTA. The primary safety endpoint was symptomatic hypotension or bradycardia up to hospital discharge. RESULTS: During the study period CCTA was performed in 947 cases. In 86% of these, oral metoprolol was the only medication required to successfully reduce HR <60 bpm. Esmolol was used in the remaining 130 patients (14%). For esmolol-treated patients mean baseline and acquisition HR were 74±14 bpm and 63±9 bpm, respectively (p<0.001). The target HR of <65 bpm was achieved in 82 of the 130 esmolol-treated patients (63%). Considering the whole population, esmolol use led to a significant increase in the primary efficacy endpoint from 86% to 95% (p<0.001). Esmolol also resulted in a statistically, but not clinically, significant reduction in systolic blood pressure (144±22 to 115±17 mmHg; p<0.001). The combined primary safety endpoint was only observed in two (1.5%) patients. CONCLUSION: Despite optimal use of oral beta-blockers, 14% of patients needed intravenous esmolol for HR control. The pre-medication combination of oral metoprolol and on-demand administration of intravenous esmolol was safe and effective and enabled 95% of patients to be imaged with HR below 65 bpm.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationRev Port Cardiol. 2016 Dec;35(12):673-678.pt_PT
dc.identifier.doi10.1016/j.repc.2016.07.004pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/2779
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevier Españapt_PT
dc.subjectHSM CARpt_PT
dc.subjectHSM IMApt_PT
dc.subjectAdrenergic beta-1 Receptor Antagonists/administration & dosagept_PT
dc.subjectAdrenergic beta-1 Receptor Antagonists/therapeutic usept_PT
dc.subjectAnti-Arrhythmia Agents/administration & dosagept_PT
dc.subjectAnti-Arrhythmia Agents/therapeutic use
dc.subjectCoronary Angiography
dc.subjectHeart Rate/drug effects
dc.subjectHeart Rate/physiology
dc.subjectInjections, Intravenous
dc.subjectMetoprolol/therapeutic use
dc.subjectMultidetector Computed Tomography
dc.subjectPropanolamines/administration & dosage
dc.subjectPropanolamines/therapeutic use
dc.subjectSalvage Therapy
dc.subjectTreatment Failure
dc.titleBailout Intravenous Esmolol for Heart Rate Control in Cardiac Computed Tomography Angiographypt_PT
dc.title.alternativeEsmolol Endovenoso em Regime Bail Out Para Controlo de Frequência Cardíaca na Tomografia Computorizada Cardíacapt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage678pt_PT
oaire.citation.issue12pt_PT
oaire.citation.startPage673pt_PT
oaire.citation.titleRevista Portuguesa de Cardiologíapt_PT
oaire.citation.volume35pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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