SPC365

Heart Rate Control in CCTA: The Incremental Benefit of Adding Ivabradine to Beta-Blockers

Session: Sessão de Posters 28 - Do diagnóstico à decisão: cuidados orientados por imagem na era moderna
Speaker: Raquel Fernandes da Silva

Congress: CPC 2026
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.2 Computed Tomography
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Raquel Fernandes da Silva; Marta Paralta de Figueiredo; Diogo Brás; Gustavo Sá Mendes; David Neves; Ângela Bento; Renato Fernandes; Rita Caldeira da Rocha; Manuel Trinca; Lino Patrício

<p style="margin-right:2px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Background: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Optimal heart rate (HR) control is critical for high-quality coronary CT angiography (CCTA). Although beta-blockers (BB) are standard premedication, many patients remain above target HR or have contraindications to BB use. Ivabradine offers an alternative mechanism for HR reduction in patients in sinus rhythm, yet its added value in patients already on chronic BB therapy during routine CCTA remains insufficiently defined.&nbsp;</span></span></span></p>

<p style="margin-right:1px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Objectives: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">To evaluate the impact of Ivabradine, alone or combined with BBs, on HR dynamics and image quality in CCTA, and to examine whether Ivabradine provides HR reduction independently of age and chronic BB use.</span></span></span></p>

<p style="margin-right:1px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Methods: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">A retrospective analysis of 447 consecutive CCTA studies performed between 2023 and 2025 was conducted. Patients were classified according to premedication strategy into two groups: BB alone or BB plus Ivabradine. Mean, minimum, and maximum HR values during scanning were recorded. Image quality was graded using a four-point ordinal scale (bad, reasonable, good, or very good). Group comparisons were performed using nonparametric tests; associations between HR parameters and image quality were assessed with Spearman correlations; and multivariable linear regression adjusted for age and chronic BB therapy was used to identify independent predictors of HR.</span></span></span></p>

<p style="margin-left:1px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Results:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"> Of the 447 CCTA studies, 280 (62.6%) received BB alone and 167 (37.4%) received BB plus Ivabradine. Image quality correlated with mean and maximum HR (both p&lt;0.001), with no association for minimum HR. Image quality did not differ significantly between groups (p=0.131). In ordinal regression adjusted for age, chronic BB therapy and mean HR, image quality remained independently associated with mean HR (p&lt;0.001), while premedication strategy was not significant (p=0.883). Among patients on chronic BB therapy, BB plus Ivabradine resulted in lower maximum HR versus BB alone (p=0.016). In multivariable linear analysis, Ivabradine independently predicted lower mean HR during CCTA (p=0.032).</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Conclusion: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Ivabradine, when added to chronic BB therapy, independently reduces mean HR and significantly attenuates HR peaks during CCTA. Although image quality did not differ significantly between groups, the overall physiological and statistical evidence suggests that Ivabradine can still be useful in CCTA premedication, particularly in beta-blocked patients or in centres using scanners that are more sensitive to heart-rate variability.</span></span></span></p>

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