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. 2014 Mar;11(1):39-43.
doi: 10.3969/j.issn.1671-5411.2014.01.011.

Safety and efficacy of intravenous esmolol before prospective electrocardiogram-triggered high-pitch spiral acquisition for computed tomography coronary angiography

Jin-Da Wang  1 , Hua-Wei Zhang  1 , Qian Xin  1 , Jun-Jie Yang  1 , Zhi-Jun Sun  1 , Hong-Bin Liu  1 , Lian Chen  1 , Luo-Shan Du  1 , Yun-Dai Chen  1
Affiliations

Safety and efficacy of intravenous esmolol before prospective electrocardiogram-triggered high-pitch spiral acquisition for computed tomography coronary angiography

Jin-Da Wang et al. J Geriatr Cardiol. 2014 Mar.

Abstract

Background: In order to acquire a high quality image with a low radiation dose, prospective electrocardiogram (ECG)-triggered computed tomography coronary angiography (CTCA) requires a stable heart rate (HR) < 65 beats/min. Esmolol has the advantage of reducing HR. The objective of this article is to assess the value of intravenous esmolol treatment before prospective ECG-triggered high-pitch spiral acquisition for CTCA.

Methods: From March 2013 to June 2013, 313 patients underwent prospective ECG-triggered CTCA. Two hundred and thirty two of them received esmolol before angiography. We retrospectively analyzed clinical characteristics, esmolol dose, radiation exposure dose, and the change in HR and blood pressure in these 232 patients.

Results: A total of 232 patients with a HR > 65 beats/min before CTCA examination received intravenous esmolol treatment (mean dose of 57.26 ± 15.39 mg). The mean initial HR (HR1), slowest HR (HR2), and the HR 30 min after HR2 (HR3) were 75.06 ± 5.59, 60.75 ± 4.00, and 75.54 ± 5.96 beats/min, respectively (HR1 vs. HR2, P < 0.0001; HR1 vs. HR3, P = 0.377). The mean time from esmolol administration to HR2 was 24.25 ± 4.97 s and the mean effective radiation dose was 2.28 ± 0.02 mSv.

Conclusions: HR could be rapidly controlled at an optimum level with intravenous esmolol before prospective ECG-triggered high-pitch spiral acquisition for CTCA. Consequently, the patients received a very low radiation dose.

Keywords: Coronary angiography; Electrocardiogram; Esmolol; Heart rate.

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Figures

Figure 1.
Figure 1.. Variations in HR after intravenous esmolol treatment.
A mean of 24.25 ± 4.97 s after intravenous esmolol, heart rate decreased from HR1 to HR2, (P = 0.000). Thirty minutes later, the heart rate increased to HR3 (HR1 vs. HR3, P = 0.377). HR: heart rate; HR1: initial heart rate; HR2: the slowest heart rate; HR3: heart rate 30 min after the slowest heart rate.
Figure 2.
Figure 2.. Variations in SBP after intravenous esmolol treatment.
After esmolol administration, SBP1 decreased to SBP2 (P = 0.000). Thirty minutes later, HR increased to SBP3 (SBP1 vs SBP3, P = 0.728). HR: heart rate; SBP: systolic blood pressure; SBP1: initial SBP; SBP2:the lowest SBP; SBP3: 30 min after the lowest SBP.
Figure 3.
Figure 3.. DBP variations after intravenous esmolol treatment.
After esmolol administration, DBP1 decreased to SBP2 (P = 0.000). Thirty minutes later, DBP returned to pre-treatment levels (DBP3; DBP1 vs. DBP3, P = 0.575). DBP: diastolic blood pressure; DBP1: initial DBP; DBP2: the lowest DBP; DBP3: 30 min after the lowest DBP.
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