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Propranolol for Heart Rate Control in Pre-TAVI Cardiac CT: A Prospective Study on Efficacy and Safety in Severe Aortic Stenosis Patients
Session:
SESSÃO DE POSTERS 51 - DIAGNÓSTICO E PROGNÓSTICO NA INTERVENÇÃO VALVULAR AÓRTICA PERCUTÂNEA
Speaker:
Ana L. Silva
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.7 Valvular Heart Disease - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Ana L. Silva; Gonçalo Ferraz Costa; Mariana Rodrigues Simões; Tatiana Pereira Dos Santos; Gonçalo Terleira Batista; Rafaela Fernandes; Vanessa Lopes; José Luís Martins; Ana Rita Ramalho; Lino Gonçalves; Rogério Teixeira
Abstract
<p>Background: Accurate heart rate (HR) control is crucial for high-quality cardiac computed tomography angiography (CCTA), especially in pre-procedural planning for transcatheter aortic valve implantation (TAVI) in severe aortic stenosis (AS) patients. The use of beta-blockers for HR reduction in AS patients has been limited due to potential hemodynamic risks. Propranolol, a non-selective beta-blocker, may offer an effective solution for this clinical challenge, though its safety and efficacy in this setting remain unclear.<br /> Objective: To evaluate the efficacy and safety of oral propranolol for HR control in patients with severe AS undergoing pre-TAVI CCTA.<br /> Methods: This prospective, single-center observational study included 113 severe AS patients undergoing CCTA pre-TAVI. Based on baseline HR, 5 mg of propranolol was given for HR 55–64 bpm, and 10 mg for HR >65 bpm. The primary outcome was achieving HR <65 bpm during CCTA. Secondary outcomes included HR reduction and propranolol-related adverse events. Data were analyzed using SPSS 27.0.<br /> Results: Among 113 patients, 73 received propranolol (97.3% at 10 mg, 2.7% at 5 mg) and 40 did not. The median age was similar between groups (84 vs. 80 years, p=0.624), with comparable proportions of females (53% vs. 46.7%, p=0.494). No significant differences were observed in hypertension, dyslipidemia, diabetes, or smoking status (p>0.3). However, atrial fibrillation (22.9% vs. 40.0%, p=0.016) and coronary artery disease (21.7% vs. 46.7%, p=0.005) were more prevalent in the non-propranolol group. Heart failure and LVEF showed no differences, but beta-blocker use was higher in the non-propranolol group (43.3% vs. 26.1%, p=0.006).<br /> At the moment of CCTA, 43.4% of the propranolol group achieved the target HR, compared to 43.3% in the non-propranolol group (X<sup>2</sup>=0.05, p=0.94). The within-group comparison showed a statistically significant increase regarding the proportion of patients achieving target HR (X<sup>2</sup>=7.37, p=0.007) in the propranolol group, but not for the non-propranolol group (X<sup>2</sup>=3.64, p=0.057).<br /> The propranolol group showed a significant HR reduction from a mean of 76.3±11 bpm at admission to a median of 66 bpm (IQR [60, 72]) at CCTA (p<0.001). In contrast, the non-propranolol group had a median HR of 61 bpm (IQR [56, 70]) at admission and 65 bpm (IQR [57, 75]) at CCTA, with no significant reduction (p=0.283).<br /> No major adverse events, including significant bradycardia (HR <40 bpm), syncope, and symptomatic hypotension, were reported. Two patients in each group experienced asymptomatic hypotension (systolic blood pressure<100 mmHg) during CCTA.<br /> Conclusion: This study suggests that oral propranolol is an effective and safe option for HR control in patients with severe AS undergoing pre-TAVI CCTA. It significantly reduced HR without causing adverse hemodynamic effects, making it a viable option for HR management in this high-risk population. </p>
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