Efficacy of bolus injections of landiolol hydrochloride as premedication in coronary artery CT angiography

doi:10.1186/s13244-024-01892-5

. 2025 Jan 10;16(1):13.

doi: 10.1186/s13244-024-01892-5.

Efficacy of bolus injections of landiolol hydrochloride as premedication in coronary artery CT angiography

Mark Barwig¹, Michael Janisch², Johannes Gessl², Wolfgang Kübler¹, Christopher König¹, Gerold Schwantzer³, Helmut Schöllnast^{4

5}

Affiliations

¹ Institute of Radiology, LKH Graz II, Graz, Austria.
² Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
³ Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.
⁴ Institute of Radiology, LKH Graz II, Graz, Austria. helmut.schoellnast@medunigraz.at.
⁵ Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria. helmut.schoellnast@medunigraz.at.

PMID: 39792205
PMCID: PMC11723858
DOI: 10.1186/s13244-024-01892-5

Efficacy of bolus injections of landiolol hydrochloride as premedication in coronary artery CT angiography

Mark Barwig et al. Insights Imaging. 2025.

. 2025 Jan 10;16(1):13.

doi: 10.1186/s13244-024-01892-5.

Authors

Mark Barwig¹, Michael Janisch², Johannes Gessl², Wolfgang Kübler¹, Christopher König¹, Gerold Schwantzer³, Helmut Schöllnast^{4

5}

Affiliations

¹ Institute of Radiology, LKH Graz II, Graz, Austria.
² Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
³ Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.
⁴ Institute of Radiology, LKH Graz II, Graz, Austria. helmut.schoellnast@medunigraz.at.
⁵ Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria. helmut.schoellnast@medunigraz.at.

PMID: 39792205
PMCID: PMC11723858
DOI: 10.1186/s13244-024-01892-5

Abstract

Purpose: To assess the efficacy of bolus injections of landiolol hydrochloride as premedication in coronary artery CT angiography (CCTA).

Methods: The study population consisted of 37 patients (17 female; median age, 56 years; IQR, 19 years; range, 19-88 years) who underwent CCTA after intravenous injection of landiolol hydrochloride due to a heart rate > 60 bpm. Landiolol hydrochloride was administered in a stepwise manner until a heart rate of ≤ 60 bpm was achieved or a maximum dose of 60 mg was reached after six injections. Heart rates routinely displayed continuously on the CT scanner before the start of the landiolol hydrochloride injection (HR_PRE), after each partial dose (HR_1-6), during the CT scan (HR_CT), and after the examination before moving from the CT table (HR_POST) were recorded. Furthermore, the blood pressure routinely measured before (BP_PRE) and after the examination before moving from the CT table (BP_POST) was recorded.

Results: A HR_CT of ≤ 60 bpm was achieved in 13 patients (35%) and a HR_CT ≤ 65 bpm was achieved in 25 patients (68%). The mean difference (± SD) between HR_PRE and HR_CT was -11 ± 9 bpm in total, -14 ± 10 bpm in patients without oral beta-blocker premedication and -6 ± 5 bpm in patients with oral Beta-blocker premedication.

Conclusions: Landiolol hydrochloride enables a reduction of the heart rate in patients with and without oral beta-blocker premedication, whereby the use of serial partial doses is a simple and effective approach in clinical routine.

Critical relevance statement: In cardiac CT, weight-independent, stepwise landiolol hydrochloride injection up to 40 mg reduces heart rate by -14 bpm without and -5 bpm with oral beta-blocker premedication, and achieves heart rates of ≤ 65 bpm in a significant proportion of patients.

Key points: The ideal heart rate for cardiac CT is ≤ 60-65 bpm, which improves image quality and reduces radiation dose. In cardiac CT, landiolol hydrochloride intravenously reduces heart rate by -14 bpm. Heart rate of ≤ 65 bpm can be achieved in a significant proportion of patients.

Keywords: Beta-adrenergic blocker; Cardiac imaging techniques; Heart rate; Heart–drug effects; Multidetector computed tomography.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This retrospective study was approved by the Ethics Committee of the Medical University of Graz, Austria (Reference Number: 34-483 ex 21/22). Informed consent was waived. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests.

Figures

**Fig. 1**
Flow chart showing patients’ inclusion and exclusion

**Fig. 2**
Mean HR and standard deviation after stepwise application of landiolol hydrochloride and during cardiac CT in patients who received the full dose of 60 mg in six injections (15 patients)

See this image and copyright information in PMC

Cited by

The Role of Landiolol in Coronary Artery Disease: Insights into Acute Coronary Syndromes, Stable Coronary Artery Disease and Computed Tomography Coronary Angiography.
Nasoufidou A, Bantidos MG, Stachteas P, Moysidis DV, Mitsis A, Fyntanidou B, Kouskouras K, Karagiannidis E, Karamitsos T, Kassimis G, Fragakis N. Nasoufidou A, et al. J Clin Med. 2025 Jul 23;14(15):5216. doi: 10.3390/jcm14155216. J Clin Med. 2025. PMID: 40806838 Free PMC article. Review.

References

1. Stocker TJ, Leipsic J, Chen MY et al (2021) Influence of heart rate on image quality and radiation dose exposure in coronary CT angiography. Radiology 300:701–703 - PubMed
1. Ablad B, Borg KO, Carlsson E et al (1975) A survey of the pharmacological properties of metoprolol in animals and man. Acta Pharmacol Toxicol 36:7–23 - PubMed
1. Tsuchiya H, Mizogami M (2013) Characteristic interactivity of landiolol, an ultra-short-acting highly selective β1-blocker, with biomimetic membranes: comparisons with β1-selective esmolol and non-selective propranolol and alprenolol. Front Pharmacol 4:150 - PMC - PubMed
1. Murakami M, Furuie H, Matsuguma K, Wanibuchi A, Kikawa S, Irie S (2005) Pharmacokinetics and pharmacodynamics of landiolol hydrochloride, an ultra short-acting β1-selective blocker, in a dose escalation regimen in healthy male volunteers. Drug Metab Pharmacokinet 20:337–344 - PubMed
1. Nasrollahi-Shirazi S, Sucic S, Yang Q, Freissmuth M, Nanoff C (2016) Comparison of the β-adrenergic receptor antagonists landiolol and esmolol: receptor selectivity, partial agonism, and pharmacochaperoning actions. J Pharmacol Exp Ther 359:73–81 - PubMed

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[1] Stocker TJ, Leipsic J, Chen MY et al (2021) Influence of heart rate on image quality and radiation dose exposure in coronary CT angiography. Radiology 300:701–703 - PubMed

[2] Stocker TJ, Leipsic J, Chen MY et al (2021) Influence of heart rate on image quality and radiation dose exposure in coronary CT angiography. Radiology 300:701–703 - PubMed

[3] Ablad B, Borg KO, Carlsson E et al (1975) A survey of the pharmacological properties of metoprolol in animals and man. Acta Pharmacol Toxicol 36:7–23 - PubMed

[4] Ablad B, Borg KO, Carlsson E et al (1975) A survey of the pharmacological properties of metoprolol in animals and man. Acta Pharmacol Toxicol 36:7–23 - PubMed

[5] Tsuchiya H, Mizogami M (2013) Characteristic interactivity of landiolol, an ultra-short-acting highly selective β1-blocker, with biomimetic membranes: comparisons with β1-selective esmolol and non-selective propranolol and alprenolol. Front Pharmacol 4:150 - PMC - PubMed

[6] Tsuchiya H, Mizogami M (2013) Characteristic interactivity of landiolol, an ultra-short-acting highly selective β1-blocker, with biomimetic membranes: comparisons with β1-selective esmolol and non-selective propranolol and alprenolol. Front Pharmacol 4:150 - PMC - PubMed

[7] Murakami M, Furuie H, Matsuguma K, Wanibuchi A, Kikawa S, Irie S (2005) Pharmacokinetics and pharmacodynamics of landiolol hydrochloride, an ultra short-acting β1-selective blocker, in a dose escalation regimen in healthy male volunteers. Drug Metab Pharmacokinet 20:337–344 - PubMed

[8] Murakami M, Furuie H, Matsuguma K, Wanibuchi A, Kikawa S, Irie S (2005) Pharmacokinetics and pharmacodynamics of landiolol hydrochloride, an ultra short-acting β1-selective blocker, in a dose escalation regimen in healthy male volunteers. Drug Metab Pharmacokinet 20:337–344 - PubMed

[9] Nasrollahi-Shirazi S, Sucic S, Yang Q, Freissmuth M, Nanoff C (2016) Comparison of the β-adrenergic receptor antagonists landiolol and esmolol: receptor selectivity, partial agonism, and pharmacochaperoning actions. J Pharmacol Exp Ther 359:73–81 - PubMed

[10] Nasrollahi-Shirazi S, Sucic S, Yang Q, Freissmuth M, Nanoff C (2016) Comparison of the β-adrenergic receptor antagonists landiolol and esmolol: receptor selectivity, partial agonism, and pharmacochaperoning actions. J Pharmacol Exp Ther 359:73–81 - PubMed

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Efficacy of bolus injections of landiolol hydrochloride as premedication in coronary artery CT angiography

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Efficacy of bolus injections of landiolol hydrochloride as premedication in coronary artery CT angiography

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