Feasibility and safety of oral propranolol for heart rate control in pre-TAVI cardiac CT in severe aortic stenosis: A prospective study

Introduction and Objectives Heart rate (HR) control may improve high-quality cardiac computed tomography angiography (CCTA) image quality in preprocedural planning for transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS). Beta-blockers, though useful for HR reduction, pose hemodynamic risks in AS patients. Propranolol, a non-selective beta blocker, may offer a safe and effective solution, but its role in this context remains uncertain. The aim of this paper is to assess the feasibility and safety of oral propranolol for HR control in severe AS patients undergoing pre-TAVI CCTA. Methods This prospective, single-center study involved 113 severe AS patients scheduled for pre-TAVI CCTA. Oral propranolol was administered according to baseline HR and individualized clinical assessment: patients with HR 55–64 bpm were eligible for 5 mg, while those with HR >65 bpm were eligible for 10 mg. Propranolol was withheld in patients with lower baseline HR or clinical/hemodynamic features favoring avoidance of beta-blockade. The primary outcome was achieving HR <65 bpm at the time of CCTA. Secondary outcomes included HR reduction and adverse events. Results Of 113 patients, 73 received propranolol and 40 were withheld propranolol. At admission, patients receiving propranolol had higher HR, whereas those not receiving propranolol more frequently had atrial fibrillation, coronary artery disease, and previous beta blocker use. Propranolol group showed significant HR reduction from 76.3 ± 11 bpm to a median HR of 66 bpm (p < 0.001). No HR reduction was noted in the non-propranolol group. At CCTA, 43.4% of propranolol patients met the target HR versus 43.3% of the non-propranolol group. No major adverse events were observed. Conclusion In selected patients with severe AS undergoing pre-TAVI CCTA, oral propranolol was associated with significant within-group HR reduction and no major adverse events. However, target HR achievement was similar between groups, and this comparison is limited by non-randomized treatment allocation and baseline differences. These findings support the feasibility and preliminary safety of propranolol, while further studies are needed to establish its efficacy and impact on image quality.