Abstract 13659: Landiolol Hydrochloride: A New Premedication for Multislice Computed Tomography Coronary Angiography
Background: Although the recent new generation multislice computed tomography (MSCT) scanners (≥64-slice) have offered an improved special and temporal resolution, an appropriate reduction in heart rate (HR) is still mandatory for obtaining good image quality and subsequent excellent diagnostic accuracy. We investigated the feasibility and safety of a recently developed, ultrashort-acting (a half-life of 4 minutes) β1-selective agent, landiolol hydrochloride, for use in MSCT coronary angiography (CA).
Methods: Landiolol was continuously administered intravenously to achieve a target HR of ≤60 bpm in 450 patients before starting MSCT-CA. Hemodynamic changes [blood pressure (BP), HR, HR variability] were evaluated before injection, during injection and after cessation of landiolol. Adverse effects of landiolol, image quality using a 5-point scale (excellent, good, moderate, heavily calcified, and blurred), and diagnostic accuracy for detection of significant coronary stenoses (≥50% lumen reduction on invasive CA) in the modified AHA 17-segment model were also evaluated.
Results: HR was significantly reduced during injection and quickly recovered after cessation of administration of landiolol. HR variability was significantly less during CT acquisition compared to that before administration of landiolol. Neither significant changes in BP over time nor serious adverse effects were observed. Approximately 90% of visible segments displayed an excellent (78%) or good (12%) image quality. The sensitivity, specificity, positive predictive value, and negative predictive value of MSCT-CA for detection of significant stenoses in assessable segments, compared to invasive CA, were excellent (per-artery: 87%, 98%, 83%, and 98%; per-segment: 88%, 97%, 81%, and 99%, respectively), providing better diagnostic accuracy than previous reports.
Conclusions: Intravenous administration of landiolol provides an easy dose-titration, leading to an appropriate reduction in HR without significant reduction in BP, which enables favorable image quality and diagnostic accuracy without adverse effects. Landiolol is a promising, safe, and feasible premedication for MSCT-CA.
- © 2010 by American Heart Association, Inc.