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Dose-finding study of landiolol hydrochloride: a short-acting β1-blocker for controlling heart rate during coronary computed-tomography angiography in Japan.

Hirano M, Hara K, Ikari Y, Jinzaki M, Iino M, Hamada C, Kuribayashi S - Adv Ther (2013)

Bottom Line: Heart rate decreased rapidly after completion of landiolol hydrochloride administration in all groups, with a heart rate reduction of 15.55 ± 6.56% in Group L, 16.48 ± 7.80% in Group M, and 21.49 ± 6.13% in Group H (Group L vs Group H, P = 0.0008; Group M vs Group H, P = 0.0109).Landiolol hydrochloride showed a rapid onset and short β-blocking effect, and was most effective at a dose of 0.5 mg/kg.However, the diagnosable proportion had no significant differences among the three groups in CCTA.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Tokyo Medical University, 6-7-1, Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan, m-hirano@tokyo-med.ac.jp.

ABSTRACT

Introduction: Coronary computed-tomography angiography (CCTA) has high diagnostic performance, but it sometimes does not allow evaluation because of artifacts. Currently, the use of a β-blocker is recommended to prevent motion artifacts, but the β-blocker (metoprolol, propranolol, etc.) commonly used has a slow onset and long duration of action. Landiolol hydrochloride is an intravenous β1-blocker with a very short half-life. We investigated the efficacy and optimal dose of this drug for reduction of heart rate in patients undergoing CCTA.

Methods: Eighty-seven subjects with ischemic heart disease were divided into three groups to receive landiolol hydrochloride at a dose of 0.125 (Group L), 0.25 (Group M), or 0.5 mg/kg (Group H). CCTA was performed at 3-7 min after administration, and heart rate, blood pressure, and image quality were assessed.

Results: Heart rate decreased rapidly after completion of landiolol hydrochloride administration in all groups, with a heart rate reduction of 15.55 ± 6.56% in Group L, 16.48 ± 7.80% in Group M, and 21.49 ± 6.13% in Group H (Group L vs Group H, P = 0.0008; Group M vs Group H, P = 0.0109). Since there was no significant difference in heart rate during imaging among the three groups, although there was a significant difference between groups L and H and groups M and H in terms of percent change in heart rate, coronary stenosis was diagnosable in all groups with no significant difference.

Conclusion: Landiolol hydrochloride showed a rapid onset and short β-blocking effect, and was most effective at a dose of 0.5 mg/kg. However, the diagnosable proportion had no significant differences among the three groups in CCTA. Therefore, the clinically recommended dose was 0.125 mg/kg or less, considering the heart rate of patients with suspected coronary stenosis during CCTA.

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Change in heart rate during CCTA, after administration of landiolol hydrochloride. CCTA coronary computed tomography angiography, CT computed tomography
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Fig3: Change in heart rate during CCTA, after administration of landiolol hydrochloride. CCTA coronary computed tomography angiography, CT computed tomography

Mentions: Heart rate began to decrease immediately after completion of study drug administration in all three dose groups (Fig. 3). The lowest heart rate was achieved within 3 min after completion of administration in 41.3% of subjects in Group L, 39.3% in Group M and 53.3% in Group H, within 5 min in 68.9% of subjects in Group L, 75.0% in Group M and 83.3% in Group H, and within 7 min in 72.3% of the subjects in Group L, 82.1% in Group M and 89.9% in Group H. The time (mean ± SD) required to reach the lowest heart rate was 5.0 ± 2.8 min in Group L, 4.5 ± 2.5 min in Group M and 3.4 ± 2.1 min in Group H. The time decreased with an increase in dose, and heart rate returned to baseline levels at 30 min after completion of landiolol hydrochloride administration.Fig. 3


Dose-finding study of landiolol hydrochloride: a short-acting β1-blocker for controlling heart rate during coronary computed-tomography angiography in Japan.

Hirano M, Hara K, Ikari Y, Jinzaki M, Iino M, Hamada C, Kuribayashi S - Adv Ther (2013)

Change in heart rate during CCTA, after administration of landiolol hydrochloride. CCTA coronary computed tomography angiography, CT computed tomography
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3824371&req=5

Fig3: Change in heart rate during CCTA, after administration of landiolol hydrochloride. CCTA coronary computed tomography angiography, CT computed tomography
Mentions: Heart rate began to decrease immediately after completion of study drug administration in all three dose groups (Fig. 3). The lowest heart rate was achieved within 3 min after completion of administration in 41.3% of subjects in Group L, 39.3% in Group M and 53.3% in Group H, within 5 min in 68.9% of subjects in Group L, 75.0% in Group M and 83.3% in Group H, and within 7 min in 72.3% of the subjects in Group L, 82.1% in Group M and 89.9% in Group H. The time (mean ± SD) required to reach the lowest heart rate was 5.0 ± 2.8 min in Group L, 4.5 ± 2.5 min in Group M and 3.4 ± 2.1 min in Group H. The time decreased with an increase in dose, and heart rate returned to baseline levels at 30 min after completion of landiolol hydrochloride administration.Fig. 3

Bottom Line: Heart rate decreased rapidly after completion of landiolol hydrochloride administration in all groups, with a heart rate reduction of 15.55 ± 6.56% in Group L, 16.48 ± 7.80% in Group M, and 21.49 ± 6.13% in Group H (Group L vs Group H, P = 0.0008; Group M vs Group H, P = 0.0109).Landiolol hydrochloride showed a rapid onset and short β-blocking effect, and was most effective at a dose of 0.5 mg/kg.However, the diagnosable proportion had no significant differences among the three groups in CCTA.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Tokyo Medical University, 6-7-1, Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan, m-hirano@tokyo-med.ac.jp.

ABSTRACT

Introduction: Coronary computed-tomography angiography (CCTA) has high diagnostic performance, but it sometimes does not allow evaluation because of artifacts. Currently, the use of a β-blocker is recommended to prevent motion artifacts, but the β-blocker (metoprolol, propranolol, etc.) commonly used has a slow onset and long duration of action. Landiolol hydrochloride is an intravenous β1-blocker with a very short half-life. We investigated the efficacy and optimal dose of this drug for reduction of heart rate in patients undergoing CCTA.

Methods: Eighty-seven subjects with ischemic heart disease were divided into three groups to receive landiolol hydrochloride at a dose of 0.125 (Group L), 0.25 (Group M), or 0.5 mg/kg (Group H). CCTA was performed at 3-7 min after administration, and heart rate, blood pressure, and image quality were assessed.

Results: Heart rate decreased rapidly after completion of landiolol hydrochloride administration in all groups, with a heart rate reduction of 15.55 ± 6.56% in Group L, 16.48 ± 7.80% in Group M, and 21.49 ± 6.13% in Group H (Group L vs Group H, P = 0.0008; Group M vs Group H, P = 0.0109). Since there was no significant difference in heart rate during imaging among the three groups, although there was a significant difference between groups L and H and groups M and H in terms of percent change in heart rate, coronary stenosis was diagnosable in all groups with no significant difference.

Conclusion: Landiolol hydrochloride showed a rapid onset and short β-blocking effect, and was most effective at a dose of 0.5 mg/kg. However, the diagnosable proportion had no significant differences among the three groups in CCTA. Therefore, the clinically recommended dose was 0.125 mg/kg or less, considering the heart rate of patients with suspected coronary stenosis during CCTA.

Show MeSH
Related in: MedlinePlus