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. 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 Barwig  1 , Michael Janisch  2 , Johannes Gessl  2 , Wolfgang Kübler  1 , Christopher König  1 , Gerold Schwantzer  3 , Helmut Schöllnast  4   5
Affiliations

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

Mark Barwig et al. Insights Imaging. .

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 (HRPRE), after each partial dose (HR1-6), during the CT scan (HRCT), and after the examination before moving from the CT table (HRPOST) were recorded. Furthermore, the blood pressure routinely measured before (BPPRE) and after the examination before moving from the CT table (BPPOST) was recorded.

Results: A HRCT of ≤ 60 bpm was achieved in 13 patients (35%) and a HRCT ≤ 65 bpm was achieved in 25 patients (68%). The mean difference (± SD) between HRPRE and HRCT 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
Fig. 1
Flow chart showing patients’ inclusion and exclusion
Fig. 2
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

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