Original Article
Bailout intravenous esmolol for heart rate control in cardiac computed tomography angiography
Esmolol endovenoso em regime bail out para controlo de frequência cardíaca na tomografia computorizada cardíaca
Lido
7025
Vezesque se leu este artigo
2146
Total PDF
4879
Total HTML
Compartilhar estatísticas
array:26 [ "pii" => "S0870255116302268" "issn" => "08702551" "doi" => "10.1016/j.repc.2016.07.004" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "896" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2016;35:673-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2556 "formatos" => array:3 [ "EPUB" => 177 "HTML" => 1905 "PDF" => 474 ] ] "Traduccion" => array:1 [ "en" => array:20 [ "pii" => "S2174204916302008" "issn" => "21742049" "doi" => "10.1016/j.repce.2016.07.005" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "896" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2016;35:673-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2478 "formatos" => array:3 [ "EPUB" => 149 "HTML" => 1979 "PDF" => 350 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Bailout intravenous esmolol for heart rate control in cardiac computed tomography angiography" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "673" "paginaFinal" => "678" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Esmolol endovenoso em regime <span class="elsevierStyleItalic">bail out</span> para controlo de frequência cardíaca na tomografia computorizada cardíaca" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1424 "Ancho" => 1374 "Tamanyo" => 109598 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Protocol flowchart. CCTA: cardiac computed tomography angiography; CT: computed tomography; HR: heart rate; IV: intravenous.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sílvia Aguiar Rosa, Ruben Ramos, Hugo Marques, Rosana Santos, Cecília Leal, Helena Casado, Márcia Saraiva, Luísa Figueiredo, Rui Cruz Ferreira" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Sílvia" "apellidos" => "Aguiar Rosa" ] 1 => array:2 [ "nombre" => "Ruben" "apellidos" => "Ramos" ] 2 => array:2 [ "nombre" => "Hugo" "apellidos" => "Marques" ] 3 => array:2 [ "nombre" => "Rosana" "apellidos" => "Santos" ] 4 => array:2 [ "nombre" => "Cecília" "apellidos" => "Leal" ] 5 => array:2 [ "nombre" => "Helena" "apellidos" => "Casado" ] 6 => array:2 [ "nombre" => "Márcia" "apellidos" => "Saraiva" ] 7 => array:2 [ "nombre" => "Luísa" "apellidos" => "Figueiredo" ] 8 => array:2 [ "nombre" => "Rui" "apellidos" => "Cruz Ferreira" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255116302268" "doi" => "10.1016/j.repc.2016.07.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116302268?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916302008?idApp=UINPBA00004E" "url" => "/21742049/0000003500000012/v2_201702040044/S2174204916302008/v2_201702040044/en/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S0870255116302347" "issn" => "08702551" "doi" => "10.1016/j.repc.2016.10.001" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "900" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2016;35:679-80" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2798 "formatos" => array:3 [ "EPUB" => 178 "HTML" => 2177 "PDF" => 443 ] ] "pt" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Comentário Editorial</span>" "titulo" => "Redução da frequência cardíaca para a tomografia computorizada cardíaca: um mal necessário?" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "679" "paginaFinal" => "680" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Heart rate reduction for cardiac computed tomography: a necessary evil?" ] ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pedro de Araújo Gonçalves" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Pedro" "apellidos" => "de Araújo Gonçalves" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204916301957" "doi" => "10.1016/j.repce.2016.10.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916301957?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116302347?idApp=UINPBA00004E" "url" => "/08702551/0000003500000012/v2_201701270020/S0870255116302347/v2_201701270020/pt/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S087025511630302X" "issn" => "08702551" "doi" => "10.1016/j.repc.2016.10.004" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "912" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2016;35:669-71" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4291 "formatos" => array:3 [ "EPUB" => 184 "HTML" => 3499 "PDF" => 608 ] ] "pt" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Comentário editorial</span>" "titulo" => "Reabilitação cardíaca em Portugal. Ponto da situação em 2013‐2014" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "669" "paginaFinal" => "671" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Cardiac rehabilitation in Portugal: The situation in 2013‐2014" ] ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Miguel Mendes" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Miguel" "apellidos" => "Mendes" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204916302021" "doi" => "10.1016/j.repce.2016.10.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916302021?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511630302X?idApp=UINPBA00004E" "url" => "/08702551/0000003500000012/v2_201701270020/S087025511630302X/v2_201701270020/pt/main.assets" ] "asociados" => array:1 [ 0 => array:20 [ "pii" => "S0870255116302347" "issn" => "08702551" "doi" => "10.1016/j.repc.2016.10.001" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "900" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2016;35:679-80" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2798 "formatos" => array:3 [ "EPUB" => 178 "HTML" => 2177 "PDF" => 443 ] ] "pt" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Comentário Editorial</span>" "titulo" => "Redução da frequência cardíaca para a tomografia computorizada cardíaca: um mal necessário?" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "679" "paginaFinal" => "680" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Heart rate reduction for cardiac computed tomography: a necessary evil?" ] ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pedro de Araújo Gonçalves" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Pedro" "apellidos" => "de Araújo Gonçalves" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204916301957" "doi" => "10.1016/j.repce.2016.10.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916301957?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116302347?idApp=UINPBA00004E" "url" => "/08702551/0000003500000012/v2_201701270020/S0870255116302347/v2_201701270020/pt/main.assets" ] ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Bailout intravenous esmolol for heart rate control in cardiac computed tomography angiography" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "673" "paginaFinal" => "678" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Sílvia Aguiar Rosa, Ruben Ramos, Hugo Marques, Rosana Santos, Cecília Leal, Helena Casado, Márcia Saraiva, Luísa Figueiredo, Rui Cruz Ferreira" "autores" => array:9 [ 0 => array:4 [ "nombre" => "Sílvia" "apellidos" => "Aguiar Rosa" "email" => array:1 [ 0 => "silviaguiarosa@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ruben" "apellidos" => "Ramos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Hugo" "apellidos" => "Marques" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Rosana" "apellidos" => "Santos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Cecília" "apellidos" => "Leal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Helena" "apellidos" => "Casado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 6 => array:3 [ "nombre" => "Márcia" "apellidos" => "Saraiva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 7 => array:3 [ "nombre" => "Luísa" "apellidos" => "Figueiredo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 8 => array:3 [ "nombre" => "Rui" "apellidos" => "Cruz Ferreira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Cardiology Department, Santa Marta Hospital, Lisbon, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Radiology Department, Santa Marta Hospital, Lisbon, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Esmolol endovenoso em regime <span class="elsevierStyleItalic">bail out</span> para controlo de frequência cardíaca na tomografia computorizada cardíaca" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 647 "Ancho" => 1580 "Tamanyo" => 44471 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Improvement in primary efficacy endpoint (heart rate <65 bpm) when intravenous esmolol was added to the heart rate reduction protocol. CCTA: cardiac computed tomography angiography; HR: heart rate.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Adequate heart rate (HR) control is paramount for optimal cardiac imaging using single-source 64-slice multidetector computed tomography (64-MSDT).<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1–5</span></a> For these scanners, HR during image acquisition should be below 65 beats per minute (bpm) and preferably lower than 60 bpm for optimal image quality.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a> However, commonly used pre-medication regimens with oral or intravenous metoprolol are frequently unsatisfactory.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">7–9</span></a> Side effects, including hypotension and bradycardia, are also points of concern.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Intravenous esmolol, due to its rapid onset and short half-life, has been reported as a valuable option for adequate HR control, either alone or in combination with oral beta-blockers.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">10–12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of the present study is to evaluate the efficacy and safety of an HR reduction protocol using intravenous esmolol as bailout for failed oral metoprolol regimens in patients undergoing coronary computed tomography (CT) angiography (CCTA).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study population</span><p id="par0020" class="elsevierStylePara elsevierViewall">Patients undergoing CCTA in a tertiary academic medical center between August 2011 and June 2014 were analyzed. Those presenting in sinus rhythm and without contraindications for beta-blockers were included. All patients had indication for coronary anatomy assessment. Nineteen patients also had associated secondary indications: percutaneous aortic valve implantation (two), paroxysmal atrial fibrillation ablation (sinus rhythm during CCTA) (three), assessment of left ventricular morphology (two), evaluation of valve heart disease (three) or ascending aorta (two), and morphological studies for congenital heart disease (seven).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patient preparation</span><p id="par0025" class="elsevierStylePara elsevierViewall">Oral metoprolol was not used for patients presenting with HR <60 bpm, who proceeded directly to the CT table. Individuals with baseline HR of 60-65 bpm or >65 bpm received 50 mg or 100 mg oral metoprolol, respectively. An additional dose of 100 mg metoprolol was administered one hour later if HR was still above 65 bpm. After repeated oral metoprolol administration another 60 min interval was allowed. Patients were then moved to the CT table. After sublingual nitrate administration and just after scouting or calcium score image acquisition (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>), an intravenous (IV) bolus of esmolol 1 or 2 mg/kg was administered if HR was >65 bpm or >70 bpm, respectively. A second bolus of esmolol was administered 1 min later if HR remained above 65 bpm using the same dosage.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Blood pressure and HR were assessed at baseline, in the CT room before and after scanning, and before discharge until systolic blood pressure (SBP) was >100 mmHg and HR >50 bpm or had returned to baseline.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Scan protocol and image reconstruction</span><p id="par0035" class="elsevierStylePara elsevierViewall">A single scanner was used for all cases (LightSpeed VCT XT, GE Healthcare, Milwaukee, USA). First, unenhanced prospective heart rate-triggered axial scanning of the heart was performed for calcium scoring (slice thickness 2.5 mm; voltage 120 kV, tube current 70 mA; 0.35 s partial rotation) just after sublingual nitrate administration. In view of the requirement for esmolol administration (HR on the CT table >65 bpm) a conservative acquisition approach was used and retrospective gating with dose modulation was selected for all these patients. The contrast-enhanced scan was obtained using Visipaque™ (iodixanol) 320 mg injected through a peripheral vein at 5 ml/s followed by a saline bolus chase. The scan parameters used were 0.625 mm collimation, rotation time 350 ms, pitch adjusted to each patient's HR, tube voltage 80-120 mV, and effective mA 100-600.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Estimated effective radiation dose was calculated by applying a factor of 0.014 to the volumetric CT dose. Calcium scoring was included in the total effective radiation dose. Electrocardiographically gated datasets were reconstructed from 40% to 80% of the R-R cycle length in 10% increments.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Endpoints</span><p id="par0045" class="elsevierStylePara elsevierViewall">The primary efficacy endpoint was HR <65 bpm during contrast image acquisition and the secondary efficacy endpoint was HR <60 bpm during contrast image acquisition.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The primary safety endpoint was symptomatic hypotension (SBP <90 mmHg) or bradycardia (heart rate <45 bpm) up to hospital discharge, while the secondary safety endpoints were SBP <90 mmHg or HR <45 bpm (with or without symptoms) up to hospital discharge.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">The statistical analysis was performed using IBM SPSS Statistics (version 22; IBM SPSS, Chicago, IL). Continuous variables were expressed as mean ± standard deviation or median ± interquartile range. Normality was tested by the Kolmogorov-Smirnov test. Study group characteristics were compared using the Student's t test or the Wilcoxon-Mann-Whitney test for continuous variables, and Pearson's chi-square test or Fisher's exact test for categorical measures, as appropriate.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">Of the 947 CCTAs performed (76% of all CCTAs performed in the study period), HR <65 bpm during CCTA acquisition was achieved in 830 cases (86%) using the oral metoprolol regimen alone. Intravenous esmolol was necessary in the other 130 patients (54% male, mean age 60.9±13.8 years and body mass index 27.40±4.42 kg/m<span class="elsevierStyleSup">2</span>) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Nearly half (53%) of the esmolol-treated patients had been pre-medicated before admission with oral beta-blockers in accordance with the indications of the referring physician.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In about one third (35%) of esmolol-treated patients, HR on presentation was <60 bpm and thus they received no oral metoprolol, but on the CT table HR increased to >65 bpm requiring IV esmolol as per protocol. The remaining 65% (84 patients) had received in-hospital oral metoprolol (mean dose 0.69 mg/kg) according to the predefined study protocol. The mean time between first oral dose of metoprolol and intravenous esmolol administration was 82±39 min. The mean esmolol dose administered was 1.54 mg/kg.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Initial mean HR in esmolol-treated patients was 74±14 bpm, which decreased to 63±9 bpm during CCTA acquisition (p<0.001), corresponding to a significant mean reduction in HR of 15±13% (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>). During CCTA HR variability, defined as (maximum HR - minimum HR)/mean HR, was 6.3±7.1 in esmolol patients.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">HR <65 bpm was achieved in 82 of the 130 esmolol-treated patients (63%). Thus, considering the entire CCTA population, the combined metoprolol/esmolol regimen led to a significant increase in the primary efficacy endpoint, from 86% to 95% (p<0.001) (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The secondary efficacy endpoint (HR <60 bpm) was reached in 47 of the 130 esmolol patients (36%).</p><p id="par0085" class="elsevierStylePara elsevierViewall">Four of the esmolol-treated patients (3%) had minimum HR below 45 bpm. Mean time to HR recovery to >60 bpm in these patients was 37.8±32.3 min. During CCTA, HR above 80 bpm was observed in five (4%) patients. Mean HR at discharge was 64±7 bpm (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>) in the esmolol group.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Esmolol use resulted in a significant reduction in mean SBP (143±21 to 115±17 mmHg; p<0.001). In 11 patients (8%) SBP decreased to levels below 90 mmHg. Mean SBP at discharge was 119±18 mmHg (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>A). Initial diastolic blood pressure was 80±12 mmHg, decreasing to 62±11 mmHg after intravenous esmolol (p<0.001). Diastolic blood pressure at discharge was 69±10 mmHg (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>B).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The combined primary safety endpoint (symptomatic hypotension or symptomatic bradycardia) was only observed in two patients (1.5%). Both cases resolved with supine positioning, intravenous fluids and atropine (1 mg) administration, without further complications.</p><p id="par0100" class="elsevierStylePara elsevierViewall">In esmolol-treated patients 113 scans (87%) were of good image quality, 10 (8%) were of moderate quality, and seven (5%) were of poor quality and considered non-diagnostic. In the latter group HR during CCTA was 75±9 bpm and HR variability was 5.3 (42.6).</p><p id="par0105" class="elsevierStylePara elsevierViewall">Retrospective gating with dose modulation was selected for all esmolol-treated patient due to high baseline HR. Mean estimated radiation dose was 9.8±10.6 mSv.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">HR while scanning should be less than 65 bpm and ideally less than 60 bpm for optimal image quality when a 64-slice MDCT scanner is to be used.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a> Despite this recommendation, in 2007 an American survey showed that there were differences in beta-blocker protocols and that a cutoff higher than 65 bpm was used by 80% of centers.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Metoprolol is the most common beta-blocker agent used to achieve HR control during CCTA. However, due to its low oral bioavailability, variable metabolism and inter-subject variability, the results are often suboptimal. This has led to the use of several alternate regimens including intravenous metoprolol, other beta-blockers such as atenolol, ivabradine, or calcium channel blockers.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">14,15</span></a> Nevertheless intravenous metoprolol, the most commonly used parenteral beta-blocker, has demonstrated limited efficacy in lowering HR.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Ivabradine has been suggested as an alternative to beta-blockers. Regimens of oral ivabradine proved more effective in reducing HR than oral metoprolol<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">16</span></a> and an intravenous protocol demonstrated efficacy and safety in patients ineligible for intravenous beta-blockers.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">17</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Esmolol may be at least as efficacious as intravenous metoprolol to achieve optimal HR.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a> However, to our knowledge there are no studies reporting on esmolol use as bailout when previous oral HR regimens have failed.</p><p id="par0130" class="elsevierStylePara elsevierViewall">In our study the oral metoprolol regimen used enabled 86% of patients to achieve target HR <65 bpm. This percentage is higher than described in previous studies. De Graaf et al. demonstrated optimal beta-blockade in 73% of CCTA patients using oral metoprolol.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">18</span></a> Intravenous metoprolol, also commonly used, again demonstrated limited efficacy in lowering HR. In a study by Jimenez-Juan et al. only 42% of patients who did not achieve HR <60 bpm with oral metoprolol reached target HR with additional intravenous metoprolol.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">19</span></a> These findings highlight the need for a more effective protocol for HR control. In addition, the rapid action and short half-life of esmolol make it an attractive drug in this setting. Similarly to data reported by Degertekin et al.,<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">10</span></a> in our study bolus esmolol produced HR below 65 bpm in 63% (82/130) of patients. Thus, the introduction of bailout intravenous esmolol enabled 95% of the entire cohort to be imaged with HR below 65 bpm. The mean HR reduction was 11 bpm, 4% of patients were imaged with HR greater than 80 bpm and only 5% of CCTA exams were considered to be non-diagnostic.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Our study suggests that despite an aggressive beta-blocker strategy, the risk of side effects was relatively small. Only 1.5% of patients had symptomatic hypotension or bradycardia. Wang et al. reported 0.4% incidence of adverse events in a Chinese population treated with intravenous esmolol only.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a> In our cohort, however, esmolol was used on top of oral metoprolol in 64% of cases, which could explain the higher incidence of side effects. Contraindications for beta-blockers are often considered a limitation for CCTA in patients with relatively high HR. Esmolol's short half-life could make it useful for patients who cannot tolerate prolonged beta-blockade.</p><p id="par0140" class="elsevierStylePara elsevierViewall">We reported a higher effective radiation dose than some real-world registries.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">20</span></a> Unlike these studies, in which both prospective and retrospective acquisition protocols are reported, herein we report on a specific population subset in which only a retrospective acquisition protocol was chosen for all patients (because of high baseline HR). Also, in our registry about 15% of esmolol-treated patients had secondary indications for scanning, such as study for transcatheter aortic valve implantation, in which the scan range is significantly greater.</p><p id="par0145" class="elsevierStylePara elsevierViewall">The introduction of high temporal resolution (83 ms) dual-source CT in clinical practice in 2005 has enabled high image quality diagnostic CCTA studies at increased HR with less dependency on HR lowering agents.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a> However, the latest generation of dual-source scanners has introduced a new scan mode, prospectively ECG-triggered helical data acquisition with very high pitch values. The high pitch enables acquisition with very low radiation exposure (<1 mSv) but low and regular HR is critical for this technique. Consequently, effective HR reduction strategies are yet again pivotal if such very low dose acquisition protocols are to be followed.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Study limitations</span><p id="par0150" class="elsevierStylePara elsevierViewall">This is a retrospective study with inherent limitations including potential selection bias. However, the HR control protocol was prospectively designed and uniformly applied to all eligible patients. Also, this was a single-center experience with a relatively small sample of esmolol-treated patients. Larger multicenter trials using placebo or intravenous metoprolol as active controls will be needed to clearly establish the role of intravenous esmolol in this setting.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusion</span><p id="par0155" class="elsevierStylePara elsevierViewall">Despite optimal use of oral metoprolol for HR control before CCTA, 14% of cases still required intravenous esmolol for HR control. Bailout administration of intravenous esmolol on the CT table was safe and effective and enabled 95% of patients to be imaged with HR below 65 bpm.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Ethical disclosures</span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Protection of human and animal subjects</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Confidentiality of data</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Right to privacy and informed consent</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflicts of interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres795324" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec793688" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres795325" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec793689" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Patient preparation" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Scan protocol and image reconstruction" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Endpoints" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Study limitations" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusion" ] 10 => array:3 [ "identificador" => "sec0060" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0065" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0070" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0075" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:2 [ "identificador" => "sec0080" "titulo" => "Conflicts of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-02-09" "fechaAceptado" => "2016-07-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec793688" "palabras" => array:3 [ 0 => "Coronary computed tomography angiography" 1 => "Esmolol" 2 => "Heart rate control" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec793689" "palabras" => array:3 [ 0 => "Angiografia coronária por tomografia computorizada" 1 => "Esmolol" 2 => "Controlo de frequência cardíaca" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the efficacy and safety of a heart rate (HR) reduction protocol using intravenous esmolol as bailout for failed oral metoprolol regimens in patients undergoing coronary computed tomography angiography (CCTA) with 64-slice multidetector computed tomography (64-MDCT).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patients who underwent cardiac 64-MDCT in a single institution between 2011 and 2014 were analyzed. Those with HR above 60 beats per minute (bpm) on presentation received oral metoprolol (50-200 mg) at least one hour before CCTA. Intravenous esmolol 1-2 mg/kg was administered as a bolus whenever HR remained over 65 bpm just before imaging. The primary efficacy endpoint was HR <65 bpm during CCTA. The primary safety endpoint was symptomatic hypotension or bradycardia up to hospital discharge.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">During the study period CCTA was performed in 947 cases. In 86% of these, oral metoprolol was the only medication required to successfully reduce HR <60 bpm. Esmolol was used in the remaining 130 patients (14%). For esmolol-treated patients mean baseline and acquisition HR were 74±14 bpm and 63±9 bpm, respectively (p<0.001). The target HR of <65 bpm was achieved in 82 of the 130 esmolol-treated patients (63%). Considering the whole population, esmolol use led to a significant increase in the primary efficacy endpoint from 86% to 95% (p<0.001). Esmolol also resulted in a statistically, but not clinically, significant reduction in systolic blood pressure (144±22 to 115±17 mmHg; p<0.001). The combined primary safety endpoint was only observed in two (1.5%) patients.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Despite optimal use of oral beta-blockers, 14% of patients needed intravenous esmolol for HR control. The pre-medication combination of oral metoprolol and on-demand administration of intravenous esmolol was safe and effective and enabled 95% of patients to be imaged with HR below 65 bpm.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Avaliar a eficácia e segurança de um protocolo de redução de frequência cardíaca (FC) utilizando esmolol endovenoso após falência de metoprolol oral, em doentes submetidos a angiografia coronária por tomografia computorizada (CCTA) de 64 cortes.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">De 2011 a 2014 foram avaliados os indivíduos submetidos a CCTA num único centro. Os indivíduos com FC >60 bpm à admissão receberam 50-200 mg de metoprolol oral pelo menos uma hora antes da CCTA. Esmolol endovenoso em bólus (1-2 mg/kg) foi administrado se FC >65 bpm imediatamente antes da aquisição de imagem. O <span class="elsevierStyleItalic">endpoint</span> primário de eficácia foi FC <65 bpm durante a aquisição de imagem com contraste. O <span class="elsevierStyleItalic">endpoint</span> primário de segurança foi hipotensão ou bradicardia sintomática durante a permanência no hospital.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Foram efetuadas 947 CCTA durante o período de estudo. Em 86% dos casos, metoprolol oral foi o único fármaco utilizado. Foi necessária a administração de esmolol em 130 (14%) doentes. Nos doentes que receberam esmolol, a FC basal reduziu em média de 74±14 bpm para 63±9 bpm (p<0,001). O objetivo primário de FC <65 bpm foi alcançado em 82 desses 130 doentes (63%). Considerando toda a população, o recurso a esmolol permitiu um aumento significativo da proporção de CCTA realizados com FC <65 bpm (86% para 95% [p<0,001]). A administração de esmolol esteve associada a redução estatisticamente, mas não clinicamente, significativa da pressão arterial sistólica (144±22 para 115±17 mmHg; p<0,001). O <span class="elsevierStyleItalic">endpoint</span> combinado de segurança foi observado em dois (1,5%) dos doentes.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusão</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Apesar da utilização sistemática de betabloqueante oral, 14% dos casos necessitaram de esmolol endovenoso para controlo adequado de FC. Pré-medicação combinada de metoprolol oral e esmolol endovenoso quando necessária foi segura e eficaz, e permitiu que 95% dos doentes apresentassem FC <65 bpm no momento da aquisição de imagem.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2373 "Ancho" => 2290 "Tamanyo" => 206335 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Protocol flowchart. CCTA: cardiac computed tomography angiography; CT: computed tomography; HR: heart rate; IV: intravenous.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1083 "Ancho" => 1622 "Tamanyo" => 62041 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Changes in heart rate after esmolol administration. HR: heart rate.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 647 "Ancho" => 1580 "Tamanyo" => 44471 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Improvement in primary efficacy endpoint (heart rate <65 bpm) when intravenous esmolol was added to the heart rate reduction protocol. CCTA: cardiac computed tomography angiography; HR: heart rate.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 910 "Ancho" => 2790 "Tamanyo" => 127022 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Changes in (A) systolic and (B) diastolic blood pressure after esmolol administration.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">BMI: body mass index; CABG: coronary artery bypass grafting; MI: myocardial infarction; PCI: percutaneous coronary intervention.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Esmolol \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No esmolol \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60.9±13.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.5±13.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.9% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.9±13.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.4±14.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI (kg/m<span class="elsevierStyleSup">2</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.40±4.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.7±2.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dyslipidemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.9% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Current smoker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous MI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous PCI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous CABG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.1% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous beta-blockers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45.6% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1331899.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics of patients receiving and not receiving esmolol.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib0115" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noninvasive coronary angiography with 64-section CT: effect of average heart rate and heart rate variability on image quality" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Leschka" 1 => "S. Wildermuth" 2 => "T. Boehm" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiol.2412051384" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "2006" "volumen" => "241" "paginaInicial" => "378" "paginaFinal" => "385" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16966483" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0120" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noninvasive coronary angiography using 64-slice spiral computed tomography in an unselected patient collective: effect of heart rate, heart rate variability and coronary calcifications on image quality and diagnostic accuracy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Brodoefel" 1 => "A. Reimann" 2 => "C. Burgstahler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejrad.2007.05.013" "Revista" => array:6 [ "tituloSerie" => "Eur J Radiol" "fecha" => "2008" "volumen" => "66" "paginaInicial" => "134" "paginaFinal" => "141" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17600648" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0125" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noninvasive coronary angiography with 16-detector row CT: effect of heart rate" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.H. Hoffmann" 1 => "H. Shi" 2 => "R. Manzke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiol.2341031408" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "2005" "volumen" => "234" "paginaInicial" => "86" "paginaFinal" => "97" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15550373" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0130" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contraindications and side effects of commonly used medications in coronary CT angiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Khan" 1 => "K.W. Cummings" 2 => "F.R. Gutierrez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10554-010-9654-8" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiovasc Imaging" "fecha" => "2011" "volumen" => "27" "paginaInicial" => "441" "paginaFinal" => "449" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20571874" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0135" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improvement of image quality with beta-blocker premedication on ECG-gated 16-MDCT coronary angiography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.S. Shim" 1 => "Y. Kim" 2 => "S.M. Lim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/ajr.184.2.01840649" "Revista" => array:6 [ "tituloSerie" => "AJR Am J Roentgenol" "fecha" => "2005" "volumen" => "184" "paginaInicial" => "649" "paginaFinal" => "654" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15671392" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0140" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influence of heart rate on vessel visibility in noninvasive coronary angiography using new multislice computed tomography: experience in 94 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Schroeder" 1 => "A.F. Kopp" 2 => "A. Kuettner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Imaging" "fecha" => "2002" "volumen" => "26" "paginaInicial" => "106" "paginaFinal" => "111" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11852217" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0145" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety, efficacy, and indications of beta-adrenergic receptor blockade to reduce heart rate prior to coronary CT angiography" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Working group “Cardiac CT” of the German Cardiac Society" "etal" => true "autores" => array:3 [ 0 => "A.A. Mahabadi" 1 => "S. Achenbach" 2 => "C. Burgstahler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiol.10100140" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "2010" "volumen" => "257" "paginaInicial" => "614" "paginaFinal" => "623" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21084413" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0150" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of pre-scan beta-blockade and impact of heart rate on image quality in patients undergoing coronary multidetector computed tomography angiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.D. Shapiro" 1 => "A.J. Pena" 2 => "J.H. Nichols" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejrad.2007.05.006" "Revista" => array:6 [ "tituloSerie" => "Eur J Radiol" "fecha" => "2008" "volumen" => "66" "paginaInicial" => "37" "paginaFinal" => "41" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17587526" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0155" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of the effectiveness of oral beta-blockade in patients for coronary computed tomographic angiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H.K. Pannu" 1 => "C. Sullivan" 2 => "S. Lai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/RCT.0b013e318075e759" "Revista" => array:6 [ "tituloSerie" => "J Comput Assist Tomogr" "fecha" => "2008" "volumen" => "32" "paginaInicial" => "247" "paginaFinal" => "251" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18379311" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0160" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety and efficacy of patient preparation with intravenous esmolol before 64-slice computed tomography coronary angiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Degertekin" 1 => "G. Gemici" 2 => "Z. Kaya" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCA.0b013e3282f27c20" "Revista" => array:6 [ "tituloSerie" => "Coron Artery Dis" "fecha" => "2008" "volumen" => "19" "paginaInicial" => "33" "paginaFinal" => "36" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18281813" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0165" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety and efficacy of intravenous esmolol before prospective electrocardiogram-triggered high-pitch spiral acquisition for computed tomography coronary angiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.D. Wang" 1 => "H.W. Zhang" 2 => "Q. Xin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3969/j.issn.1671-5411.2014.01.011" "Revista" => array:6 [ "tituloSerie" => "J Geriatr Cardiol" "fecha" => "2014" "volumen" => "11" "paginaInicial" => "39" "paginaFinal" => "43" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24748880" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0170" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Esmolol is noninferior to metoprolol in achieving a target heart rate of 65 beats/min in patients referred to coronary CT angiography: a randomized controlled clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Maurovich-Horvat" 1 => "M. Károlyi" 2 => "T. Horváth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcct.2015.02.001" "Revista" => array:6 [ "tituloSerie" => "J Cardiovasc Comput Tomogr" "fecha" => "2015" "volumen" => "9" "paginaInicial" => "139" "paginaFinal" => "145" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25819196" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0175" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "64-MDCT angiography of the coronary arteries: nationwide survey of patient preparation practice" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P.T. Johnson" 1 => "J. Eng" 2 => "H.K. Pannu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/AJR.07.2620" "Revista" => array:6 [ "tituloSerie" => "AJR Am J Roentgenol" "fecha" => "2008" "volumen" => "190" "paginaInicial" => "743" "paginaFinal" => "747" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18287447" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0180" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High-dose intravenous metoprolol usage for reducing heart rate at CT coronary angiography: efficacy and safety" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V.M. Raju" 1 => "O.E. Gosling" 2 => "G. Morgan-Hughes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.crad.2014.03.003" "Revista" => array:6 [ "tituloSerie" => "Clin Radiol" "fecha" => "2014" "volumen" => "69" "paginaInicial" => "739" "paginaFinal" => "744" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24824980" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0185" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "“In-house” pharmacological management for computed tomography coronary angiography: heart rate reduction, timing and safety of different drugs used during patient preparation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E. Maffei" 1 => "A.A. Palumbo" 2 => "C. Martini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00330-009-1509-0" "Revista" => array:6 [ "tituloSerie" => "Eur Radiol" "fecha" => "2009" "volumen" => "19" "paginaInicial" => "2931" "paginaFinal" => "2940" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19597820" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0190" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety and efficacy of oral ivabradine as a heart rate-reducing agent in patients undergoing CT coronary angiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K.K. Adile" 1 => "A. Kapoor" 2 => "S.K. Jain" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1259/bjr/22102914" "Revista" => array:6 [ "tituloSerie" => "Br J Radiol" "fecha" => "2012" "volumen" => "85" "paginaInicial" => "e424" "paginaFinal" => "e428" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22815422" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0195" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intravenous ivabradine for control of heart rate during coronary CT angiography: a randomized, double-blind, placebo-controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Cademartiri" 1 => "J. Garot" 2 => "M. Tendera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcct.2015.04.005" "Revista" => array:6 [ "tituloSerie" => "J Cardiovasc Comput Tomogr" "fecha" => "2015" "volumen" => "9" "paginaInicial" => "286" "paginaFinal" => "294" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26088378" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0200" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of contraindications and efficacy of oral beta blockade before computed tomographic coronary angiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F.R. de Graaf" 1 => "J.D. Schuijf" 2 => "J.E. van Velzen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjcard.2009.10.058" "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "2010" "volumen" => "105" "paginaInicial" => "767" "paginaFinal" => "772" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20211317" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0205" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Failed heart rate control with oral metoprolol prior to coronary CT angiography: effect of additional intravenous metoprolol on heart rate, image quality and radiation dose" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L. Jiménez-Juan" 1 => "E.T. Nguyen" 2 => "B.J. Wintersperger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10554-012-0049-x" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiovasc Imaging" "fecha" => "2013" "volumen" => "29" "paginaInicial" => "199" "paginaFinal" => "206" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22527260" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0210" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effective radiation dose of three diagnostic tests in cardiology: single photon emission computed tomography, invasive coronary angiography and cardiac computed tomography angiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. de Araújo Gonçalves" 1 => "P. Jerónimo Sousa" 2 => "R. Calé" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2013.05.005" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2013" "volumen" => "32" "paginaInicial" => "981" "paginaFinal" => "986" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24287017" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0215" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dual-source CT coronary angiography without heart rate or rhythm control in comparison with conventional coronary angiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "X.M. Fang" 1 => "H.W. Chen" 2 => "X.Y. Hu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10554-010-9686-0" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiovasc Imaging" "fecha" => "2010" "volumen" => "26" "paginaInicial" => "323" "paginaFinal" => "331" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20730495" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0220" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Achenbach" 1 => "M. Marwan" 2 => "D. Ropers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehp470" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2010" "volumen" => "31" "paginaInicial" => "340" "paginaFinal" => "346" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19897497" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003500000012/v2_201701270020/S0870255116302268/v2_201701270020/en/main.assets" "Apartado" => array:4 [ "identificador" => "29261" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Artigos Originais" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003500000012/v2_201701270020/S0870255116302268/v2_201701270020/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116302268?idApp=UINPBA00004E" ]
| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 6 | 6 | 12 |
| 2024 Outubro | 52 | 38 | 90 |
| 2024 Setembro | 78 | 30 | 108 |
| 2024 Agosto | 85 | 33 | 118 |
| 2024 Julho | 74 | 42 | 116 |
| 2024 Junho | 74 | 38 | 112 |
| 2024 Maio | 75 | 27 | 102 |
| 2024 Abril | 74 | 31 | 105 |
| 2024 Maro | 59 | 27 | 86 |
| 2024 Fevereiro | 51 | 26 | 77 |
| 2024 Janeiro | 58 | 53 | 111 |
| 2023 Dezembro | 54 | 27 | 81 |
| 2023 Novembro | 48 | 32 | 80 |
| 2023 Outubro | 37 | 25 | 62 |
| 2023 Setembro | 46 | 22 | 68 |
| 2023 Agosto | 65 | 22 | 87 |
| 2023 Julho | 50 | 12 | 62 |
| 2023 Junho | 55 | 18 | 73 |
| 2023 Maio | 64 | 29 | 93 |
| 2023 Abril | 51 | 10 | 61 |
| 2023 Maro | 73 | 24 | 97 |
| 2023 Fevereiro | 51 | 23 | 74 |
| 2023 Janeiro | 32 | 24 | 56 |
| 2022 Dezembro | 52 | 24 | 76 |
| 2022 Novembro | 81 | 37 | 118 |
| 2022 Outubro | 59 | 22 | 81 |
| 2022 Setembro | 58 | 38 | 96 |
| 2022 Agosto | 49 | 42 | 91 |
| 2022 Julho | 75 | 49 | 124 |
| 2022 Junho | 43 | 46 | 89 |
| 2022 Maio | 44 | 36 | 80 |
| 2022 Abril | 56 | 41 | 97 |
| 2022 Maro | 57 | 56 | 113 |
| 2022 Fevereiro | 40 | 36 | 76 |
| 2022 Janeiro | 49 | 45 | 94 |
| 2021 Dezembro | 29 | 35 | 64 |
| 2021 Novembro | 47 | 40 | 87 |
| 2021 Outubro | 47 | 52 | 99 |
| 2021 Setembro | 28 | 35 | 63 |
| 2021 Agosto | 39 | 35 | 74 |
| 2021 Julho | 25 | 23 | 48 |
| 2021 Junho | 28 | 23 | 51 |
| 2021 Maio | 48 | 45 | 93 |
| 2021 Abril | 58 | 87 | 145 |
| 2021 Maro | 68 | 16 | 84 |
| 2021 Fevereiro | 67 | 15 | 82 |
| 2021 Janeiro | 24 | 26 | 50 |
| 2020 Dezembro | 49 | 12 | 61 |
| 2020 Novembro | 34 | 20 | 54 |
| 2020 Outubro | 35 | 20 | 55 |
| 2020 Setembro | 73 | 13 | 86 |
| 2020 Agosto | 20 | 10 | 30 |
| 2020 Julho | 48 | 13 | 61 |
| 2020 Junho | 47 | 13 | 60 |
| 2020 Maio | 54 | 8 | 62 |
| 2020 Abril | 54 | 24 | 78 |
| 2020 Maro | 52 | 11 | 63 |
| 2020 Fevereiro | 91 | 21 | 112 |
| 2020 Janeiro | 60 | 5 | 65 |
| 2019 Dezembro | 55 | 9 | 64 |
| 2019 Novembro | 40 | 10 | 50 |
| 2019 Outubro | 31 | 7 | 38 |
| 2019 Setembro | 81 | 6 | 87 |
| 2019 Agosto | 34 | 7 | 41 |
| 2019 Julho | 34 | 11 | 45 |
| 2019 Junho | 33 | 13 | 46 |
| 2019 Maio | 48 | 10 | 58 |
| 2019 Abril | 23 | 24 | 47 |
| 2019 Maro | 55 | 11 | 66 |
| 2019 Fevereiro | 47 | 16 | 63 |
| 2019 Janeiro | 34 | 7 | 41 |
| 2018 Dezembro | 54 | 19 | 73 |
| 2018 Novembro | 75 | 8 | 83 |
| 2018 Outubro | 216 | 26 | 242 |
| 2018 Setembro | 42 | 14 | 56 |
| 2018 Agosto | 26 | 10 | 36 |
| 2018 Julho | 24 | 6 | 30 |
| 2018 Junho | 46 | 7 | 53 |
| 2018 Maio | 43 | 10 | 53 |
| 2018 Abril | 75 | 9 | 84 |
| 2018 Maro | 50 | 10 | 60 |
| 2018 Fevereiro | 27 | 5 | 32 |
| 2018 Janeiro | 26 | 7 | 33 |
| 2017 Dezembro | 58 | 11 | 69 |
| 2017 Novembro | 61 | 12 | 73 |
| 2017 Outubro | 43 | 10 | 53 |
| 2017 Setembro | 42 | 10 | 52 |
| 2017 Agosto | 43 | 12 | 55 |
| 2017 Julho | 28 | 10 | 38 |
| 2017 Junho | 33 | 9 | 42 |
| 2017 Maio | 31 | 11 | 42 |
| 2017 Abril | 24 | 3 | 27 |
| 2017 Maro | 38 | 4 | 42 |
| 2017 Fevereiro | 30 | 5 | 35 |
| 2017 Janeiro | 36 | 19 | 55 |
| 2016 Dezembro | 89 | 59 | 148 |
| 2016 Novembro | 4 | 16 | 20 |
Mostrar tudo
