High-dose intravenous metoprolol usage for reducing heart rate at CT coronary angiography: Efficacy and safety

Aim To evaluate the usage, safety, and efficacy of high-dose intravenous metoprolol for heart rate reduction in computer tomographic (CT) coronary angiography. Materials and methods As this was retrospective analysis of anonymous data, medical ethics committee approval was waived by the regional hea...

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Veröffentlicht in:Clinical radiology 2014-07, Vol.69 (7), p.739-744
Hauptverfasser: Raju, V.M, Gosling, O.E, Morgan-Hughes, G, Colliver, R.J, Iyengar, S, Dissanayake, P, Roobottom, C.A
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container_end_page 744
container_issue 7
container_start_page 739
container_title Clinical radiology
container_volume 69
creator Raju, V.M
Gosling, O.E
Morgan-Hughes, G
Colliver, R.J
Iyengar, S
Dissanayake, P
Roobottom, C.A
description Aim To evaluate the usage, safety, and efficacy of high-dose intravenous metoprolol for heart rate reduction in computer tomographic (CT) coronary angiography. Materials and methods As this was retrospective analysis of anonymous data, medical ethics committee approval was waived by the regional health research authority. Patients, who had known iodinated contrast medium allergy, contraindications to β-blockers, atrial fibrillation, and indications other than suspected coronary artery disease, were excluded from analysis. The ultimate study population of 662 were analysed with details of intravenous metoprolol doses, complications, heart rate before administration of intravenous metoprolol (resting heart rate, RHR), heart rate at acquisition of scan (acquisition heart rate, AHR), and usage of low radiation dose protocols. Results Of the ultimate study population of 662 patients, 183 had no intravenous metoprolol with mean acquisition heart rate (AHR) of 58 beats per minute (bpm), 257 had 1–15 mg intravenous metoprolol with mean AHR of 57 bpm, 114 had 16–29 mg intravenous metoprolol with mean AHR of 62 bpm and 108 had ≥30 mg intravenous metoprolol with mean AHR of 66 bpm. In the group receiving intravenous metoprolol, average usage was 19 mg (maximum 67 mg) with average reduction in HR of 15 bpm. There were no clinical incidents in relation to the use of high-dose intravenous metoprolol. Conclusion Higher doses of intravenous metoprolol are beneficial in achieving target heart rates to facilitate usage of low radiation dose protocols. With appropriate exclusion criteria, higher doses of intravenous metoprolol, well in excess of 15 mg, can be safely administered when carefully titrated.
doi_str_mv 10.1016/j.crad.2014.03.003
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Materials and methods As this was retrospective analysis of anonymous data, medical ethics committee approval was waived by the regional health research authority. Patients, who had known iodinated contrast medium allergy, contraindications to β-blockers, atrial fibrillation, and indications other than suspected coronary artery disease, were excluded from analysis. The ultimate study population of 662 were analysed with details of intravenous metoprolol doses, complications, heart rate before administration of intravenous metoprolol (resting heart rate, RHR), heart rate at acquisition of scan (acquisition heart rate, AHR), and usage of low radiation dose protocols. Results Of the ultimate study population of 662 patients, 183 had no intravenous metoprolol with mean acquisition heart rate (AHR) of 58 beats per minute (bpm), 257 had 1–15 mg intravenous metoprolol with mean AHR of 57 bpm, 114 had 16–29 mg intravenous metoprolol with mean AHR of 62 bpm and 108 had ≥30 mg intravenous metoprolol with mean AHR of 66 bpm. In the group receiving intravenous metoprolol, average usage was 19 mg (maximum 67 mg) with average reduction in HR of 15 bpm. There were no clinical incidents in relation to the use of high-dose intravenous metoprolol. Conclusion Higher doses of intravenous metoprolol are beneficial in achieving target heart rates to facilitate usage of low radiation dose protocols. With appropriate exclusion criteria, higher doses of intravenous metoprolol, well in excess of 15 mg, can be safely administered when carefully titrated.</description><identifier>ISSN: 0009-9260</identifier><identifier>EISSN: 1365-229X</identifier><identifier>DOI: 10.1016/j.crad.2014.03.003</identifier><identifier>PMID: 24824980</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adrenergic beta-1 Receptor Antagonists - administration &amp; dosage ; Adult ; Aged ; Analysis of Variance ; Coronary Angiography - methods ; Heart Rate - drug effects ; Humans ; Infusions, Intravenous ; Metoprolol - administration &amp; dosage ; Middle Aged ; Radiology ; Retrospective Studies ; Tomography, Spiral Computed</subject><ispartof>Clinical radiology, 2014-07, Vol.69 (7), p.739-744</ispartof><rights>The Royal College of Radiologists</rights><rights>2014 The Royal College of Radiologists</rights><rights>Copyright © 2014 The Royal College of Radiologists. 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Materials and methods As this was retrospective analysis of anonymous data, medical ethics committee approval was waived by the regional health research authority. Patients, who had known iodinated contrast medium allergy, contraindications to β-blockers, atrial fibrillation, and indications other than suspected coronary artery disease, were excluded from analysis. The ultimate study population of 662 were analysed with details of intravenous metoprolol doses, complications, heart rate before administration of intravenous metoprolol (resting heart rate, RHR), heart rate at acquisition of scan (acquisition heart rate, AHR), and usage of low radiation dose protocols. Results Of the ultimate study population of 662 patients, 183 had no intravenous metoprolol with mean acquisition heart rate (AHR) of 58 beats per minute (bpm), 257 had 1–15 mg intravenous metoprolol with mean AHR of 57 bpm, 114 had 16–29 mg intravenous metoprolol with mean AHR of 62 bpm and 108 had ≥30 mg intravenous metoprolol with mean AHR of 66 bpm. In the group receiving intravenous metoprolol, average usage was 19 mg (maximum 67 mg) with average reduction in HR of 15 bpm. There were no clinical incidents in relation to the use of high-dose intravenous metoprolol. Conclusion Higher doses of intravenous metoprolol are beneficial in achieving target heart rates to facilitate usage of low radiation dose protocols. With appropriate exclusion criteria, higher doses of intravenous metoprolol, well in excess of 15 mg, can be safely administered when carefully titrated.</description><subject>Adrenergic beta-1 Receptor Antagonists - administration &amp; dosage</subject><subject>Adult</subject><subject>Aged</subject><subject>Analysis of Variance</subject><subject>Coronary Angiography - methods</subject><subject>Heart Rate - drug effects</subject><subject>Humans</subject><subject>Infusions, Intravenous</subject><subject>Metoprolol - administration &amp; dosage</subject><subject>Middle Aged</subject><subject>Radiology</subject><subject>Retrospective Studies</subject><subject>Tomography, Spiral Computed</subject><issn>0009-9260</issn><issn>1365-229X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc2LFDEQxRtR3NnVf8CD5Oil28pHf4kIy7DuCgseXMFbSCeVnow9yZh0L8x_b5pZPXjwVFTx3oP3q6J4Q6GiQJv3-0pHZSoGVFTAKwD-rNhQ3tQlY_2P58UGAPqyZw1cFJcp7ddVMPGyuGCiY6LvYFP4OzfuShMSEufnqB7RhyWRA87hGMMUJrIkNSKxIZKIZtHOj2SHKs4kqhmJmsn2gegQg1fxRJQfXRijOu5OH8iNtU4rvV4NScrifHpVvLBqSvj6aV4V3z_fPGzvyvuvt1-21_elFpTOpR36tu1Ep2nbWa2YQQRqu3rQjTEtmlpY29nWqoG3TYegByHYAE3fWIqdaflV8e6cm0v8WjDN8uCSxmlSHnM_SWtO-5r2vM5SdpbqGFKKaOUxukMuIynIlbPcy5WzXDlL4DJzzqa3T_nLcEDz1_IHbBZ8PAswt3x0GGXSDr1G4yLqWZrg_p__6R-7npzPNKefeMK0D0v0mZ-kMjEJ8tv62vXRVABQ4Iz_BiHCpXI</recordid><startdate>20140701</startdate><enddate>20140701</enddate><creator>Raju, V.M</creator><creator>Gosling, O.E</creator><creator>Morgan-Hughes, G</creator><creator>Colliver, R.J</creator><creator>Iyengar, S</creator><creator>Dissanayake, P</creator><creator>Roobottom, C.A</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140701</creationdate><title>High-dose intravenous metoprolol usage for reducing heart rate at CT coronary angiography: Efficacy and safety</title><author>Raju, V.M ; Gosling, O.E ; Morgan-Hughes, G ; Colliver, R.J ; Iyengar, S ; Dissanayake, P ; Roobottom, C.A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-fb977848c178fca2dee01f85bc6dd7ed54ff8f7fab3768e0cb442b0696f1e8d73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adrenergic beta-1 Receptor Antagonists - administration &amp; dosage</topic><topic>Adult</topic><topic>Aged</topic><topic>Analysis of Variance</topic><topic>Coronary Angiography - methods</topic><topic>Heart Rate - drug effects</topic><topic>Humans</topic><topic>Infusions, Intravenous</topic><topic>Metoprolol - administration &amp; dosage</topic><topic>Middle Aged</topic><topic>Radiology</topic><topic>Retrospective Studies</topic><topic>Tomography, Spiral Computed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Raju, V.M</creatorcontrib><creatorcontrib>Gosling, O.E</creatorcontrib><creatorcontrib>Morgan-Hughes, G</creatorcontrib><creatorcontrib>Colliver, R.J</creatorcontrib><creatorcontrib>Iyengar, S</creatorcontrib><creatorcontrib>Dissanayake, P</creatorcontrib><creatorcontrib>Roobottom, C.A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Raju, V.M</au><au>Gosling, O.E</au><au>Morgan-Hughes, G</au><au>Colliver, R.J</au><au>Iyengar, S</au><au>Dissanayake, P</au><au>Roobottom, C.A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>High-dose intravenous metoprolol usage for reducing heart rate at CT coronary angiography: Efficacy and safety</atitle><jtitle>Clinical radiology</jtitle><addtitle>Clin Radiol</addtitle><date>2014-07-01</date><risdate>2014</risdate><volume>69</volume><issue>7</issue><spage>739</spage><epage>744</epage><pages>739-744</pages><issn>0009-9260</issn><eissn>1365-229X</eissn><abstract>Aim To evaluate the usage, safety, and efficacy of high-dose intravenous metoprolol for heart rate reduction in computer tomographic (CT) coronary angiography. Materials and methods As this was retrospective analysis of anonymous data, medical ethics committee approval was waived by the regional health research authority. Patients, who had known iodinated contrast medium allergy, contraindications to β-blockers, atrial fibrillation, and indications other than suspected coronary artery disease, were excluded from analysis. The ultimate study population of 662 were analysed with details of intravenous metoprolol doses, complications, heart rate before administration of intravenous metoprolol (resting heart rate, RHR), heart rate at acquisition of scan (acquisition heart rate, AHR), and usage of low radiation dose protocols. Results Of the ultimate study population of 662 patients, 183 had no intravenous metoprolol with mean acquisition heart rate (AHR) of 58 beats per minute (bpm), 257 had 1–15 mg intravenous metoprolol with mean AHR of 57 bpm, 114 had 16–29 mg intravenous metoprolol with mean AHR of 62 bpm and 108 had ≥30 mg intravenous metoprolol with mean AHR of 66 bpm. In the group receiving intravenous metoprolol, average usage was 19 mg (maximum 67 mg) with average reduction in HR of 15 bpm. There were no clinical incidents in relation to the use of high-dose intravenous metoprolol. Conclusion Higher doses of intravenous metoprolol are beneficial in achieving target heart rates to facilitate usage of low radiation dose protocols. With appropriate exclusion criteria, higher doses of intravenous metoprolol, well in excess of 15 mg, can be safely administered when carefully titrated.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>24824980</pmid><doi>10.1016/j.crad.2014.03.003</doi><tpages>6</tpages></addata></record>
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subjects Adrenergic beta-1 Receptor Antagonists - administration & dosage
Adult
Aged
Analysis of Variance
Coronary Angiography - methods
Heart Rate - drug effects
Humans
Infusions, Intravenous
Metoprolol - administration & dosage
Middle Aged
Radiology
Retrospective Studies
Tomography, Spiral Computed
title High-dose intravenous metoprolol usage for reducing heart rate at CT coronary angiography: Efficacy and safety
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