Diltiazem as an alternative to beta-blocker in coronary artery computed tomography angiography.

Journal Article (Journal Article)

BACKGROUND: Reducing heart rate (HR) in CT angiography of the coronary arteries (CTACor) is critical to image quality. The effectiveness of calcium channel blockers as alternatives for patients with contraindications to beta-blockers has not been established. OBJECTIVES: To compare the efficacy in the reduction of HR and RR variability of metoprolol and diltiazem in CTACor. METHODS: Prospective, randomized, open study that included patients with clinical indication of CTACor in sinus rhythm with HR > 70 bpm and no use of agents that could interfere with HR. Fifty patients were randomized to the groups: metoprolol IV 5-15 mg or up to HR ≤ 60 bpm (M), and diltiazem IV 0.25 to 0.60 mg/kg or up to HR ≤ 60 bpm (D). Blood pressure (BP) and HR were measured at baseline, 1 minute, 3 minutes and 5 minutes after the agents, at the acquisition and after CTACor. RESULTS: HR reduction in absolute values was higher in group M than in group D (1, 3, 5 min, acquisition and post-test). The percentage reduction of HR was significantly higher in group M only 1 min and 3 min after the start of the agents. There was no difference in 5 min at acquisition and after examination. The percentage RR variability in group D was lower than that in group M during acquisition (RR variability/mean HR of acquisition). A single case of AVB, 2:1 Mobitz I occurred, which was spontaneously reverted (group D). CONCLUSION: We conclude that diltiazem is an effective and safe alternative to beta-blockers in the reduction of HR when performing computed tomography angiography of coronary arteries.

Full Text

Duke Authors

Cited Authors

  • Rochitte, CE; Azevedo, GSA; Shiozaki, AA; Azevedo, CF; Kalil Filho, R

Published Date

  • August 2012

Published In

Volume / Issue

  • 99 / 2

Start / End Page

  • 706 - 713

PubMed ID

  • 22735866

Electronic International Standard Serial Number (EISSN)

  • 1678-4170

Digital Object Identifier (DOI)

  • 10.1590/s0066-782x2012005000059


  • eng por

Conference Location

  • Brazil