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    Comparison of different strategies of ivabradine premedication for heart rate reduction before coronary computed tomography angiography
    (ELSEVIER SCIENCE INC, 2014) Celik, Omer; Atasoy, Mehmet M.; Erturk, Mehmet; Yalcin, Arif A.; Aksu, Hale U.; Diker, Mustafa; Akturk, Faruk I.; Erkanli, Korhan; Atasoy, Isil; Kiris, Adem
    Objective: The aim of this study was to assess the effectiveness and safety of different strategies of ivabradine therapy by comparing the effects on heart rate (HR), blood pressure (BP), and image quality of coronary CT angiography (CTA). Methods: A total of 192 consecutive patients were randomly assigned to 3 groups of oral premedication with ivabradine 15 mg (single dose), 10 mg (single dose), and 5 mg twice daily for 5 days, prospectively. Patients using HR-lowering drugs and patients with beta-blockade contraindication were excluded. The target HR was 65 beats/thin. In addition 5 to 10 mg of intravenous metoprolol was administered to the patients at the CT unit, if required. The systolic and diastolic blood BP values and the HRs were recorded. Image quality was assessed for 8 of 15 coronary segments with a 4-point grading scale. Results were compared with the Kruskal-Wallis test, one-way ANOVA, and chi(2) test. Results: Reductions in mean HR after the treatment were 18 +/- 6, 14 +/- 4, and 17 +/- 7 beats/min for groups 1, 2, and 3, respectively. With the total additional therapies, 81.3%, 67.2%, and 84.3% of the patients achieved HR < 65 beats/min in groups 1, 2, and 3, respectively. The mean BP values before coronary CTA were not significantly changed except for patients in group 2. Unacceptable (score 0) image quality was obtained in only 4.5%, 10.2%, and 4.2% of all the coronary segments, in groups 1, 2, and 3, respectively. Conclusions: Our study indicates that coronary CTA with premedication with oral ivabradine in all 3 strategies is safe and effective in reducing HR, in particular with a beta-blockade combination. All 3 ivabraline regimes may be an alternative strategy for HR lowering in patients undergoing coronary CTA. Ivabradine 15 mg (single dose) and ivabradine 5 mg twice daily for 5 days are superior to the ivabradine 10-mg single-dose regime for HR lowering without adjunctive intravenous beta-blocker usage. (C) 2014 Society of Cardiovascular Computed Tomography. All rights reserved.
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    Nonsevere Acute Pulmonary Embolism: Prognostic CT Pulmonary Angiography Findings
    (LIPPINCOTT WILLIAMS & WILKINS, 2015) Atasoy, Mehmet Mahir; Sariman, Nesrin; Levent, Ender; Cubuk, Rahmi; Celik, Omer; Saygi, Attila; Atasoy, Isil; Sahin, Sinan
    Purpose: To retrospectively evaluate the prognostic parameters of computed tomography (CT) pulmonary angiographic findings in nonsevere (hemodynamically stable) pulmonary embolism(PE) patients and to assess the predictive value of these parameters for mortality within 1 month of the initial diagnosis. Materials and Methods: Retrospectively, 67 consecutive patients (28 men, 39 women; mean age, 63.25 +/- 18 years) from 2 centers with nonsevere PE diagnosed using CT and a clinical evaluation were included in the current study. Using consensus reading, 2 readers blinded to the patients' clinical outcomes quantified the right ventricle short axis to left ventricle short axis ratio in the axial plane, vascular measurements, reflux of contrast medium into the inferior vena cava and azygos vein, ventricular septal bowing, and clot load using the Qanadli scoring system. The Simplified Pulmonary Embolism Severity Index (sPESI) and pulmonary parenchymal findings were also evaluated. All CT pulmonary angiographic parameters were compared with the risk of death within 1 month using logistic regression analysis. Results: Fifty-nine patients survived (88.1%), and 8 patients (11.9%) died because of PE. The sPESI and 2 parenchymal findings (multiple wedge-shaped opacities or consolidation accompanied by a wedge-shaped opacity) were significantly related tomortality. In the univariate analysis, neither the cardiovascular CT parameters nor the clot burden was significant between the survivors and nonsurvivors (P > 0.05). Conclusions: In clinically nonsevere PE patients, the sPESI and significant parenchymal findings were the CT parameters related to 1-month mortality.