JP5648287B2 - Coronary arterial imaging ability improving agent - Google Patents

Description

  The present invention relates to a patient who undergoes coronary artery imaging diagnosis by multi-slice helical CT, and is administered in combination with a contrast agent to reduce the heart rate of the patient and improve coronary artery visualization ability. The present invention relates to an agent for improving imaging performance, wherein about 0.05 mg to about 2 mg of landiolol hydrochloride per day is intravenously administered for about 1 minute.

  Currently, coronary angiography using a catheter is widely used to evaluate coronary artery lesions in ischemic heart diseases such as angina pectoris and acute myocardial infarction. Recently, multi-slice helical computed tomography (CT) Hereinafter, coronary angiography using MSCT may be abbreviated as a noninvasive and inexpensive examination method that can replace coronary angiography using a catheter.

  However, it is known that coronary angiography using MSCT has poor rendering ability and it is difficult to obtain clear image quality. The reason for this is that the coronary artery has a narrow blood vessel, meanders, and constantly moves with heartbeat and respiratory movements, despite the need for high spatial resolution to evaluate stenosis and occlusion of the coronary artery. It is done. Further, at the time of MSCT diagnosis, patients often have a higher heart rate than usual due to tension, making it more difficult to obtain a clear image. At present, the ability to visualize coronary arteries during coronary angiography by MSCT has improved due to advances in equipment and image analysis methods, but heart rate management during MSCT angiography remains an important issue.

  In fact, in the medical field, oral β-blockers are sometimes administered to reduce heart rate (see Non-Patent Document 1 and Non-Patent Document 2). Furthermore, Patent Document 1 discloses a diagnostic imaging method using a short-acting β-blocker as an diagnostic imaging aid. The administration method of the short-acting β-blocker shown therein is an administration method with two administration steps, in which a rapid intravenous administration step and a continuous intravenous administration step with different doses are combined. The intravenous continuous administration step in this method is a step of continuously administering a short-acting β-blocker using a device such as an infusion pump or an infusion pump for a long time. Since an infusion pump is usually used for administration of a contrast agent, in the method disclosed in Patent Document 1, a patient is given two different intravenous injections for administration of a contrast agent and β-blocker that is an imaging aid. There is a possibility that the administration route can be secured, so that the administration work is complicated, the burden is great for the patient, and improvement of medication compliance has been demanded.

  By the way, landiolol hydrochloride is a short-acting β-blocker, and tachyarrhythmia during surgery (for example, atrial fibrillation, atrial flutter, sinus tachycardia), tachycardia under monitoring of hemodynamics after surgery. It is used for arrhythmia (for example, atrial fibrillation, atrial flutter, sinus tachycardia) (see Patent Document 2).

  Since landiolol hydrochloride is rapidly degraded to inactive form by blood and liver esterases, it has a characteristic that the half-life in blood is extremely short, about 4 minutes, compared to existing β-blockers. Therefore, in the clinical field, in order to maintain the target heart rate for the required time, the administration process of twice intravenous administration for 5 to 10 minutes after rapid intravenous administration for 1 minute is performed twice. The method was taken.

In addition, bolus administration of landiolol hydrochloride suppressed the increase in heart rate that occurred during tracheal intubation or during arousal and extubation in patients under general anesthesia during surgery, and tachycardia or paroxysmal supraventricularity due to pheochromocytoma It is known that sympathetic tachycardia was suppressed (see Non-Patent Document 3, Non-Patent Document 4, Non-Patent Document 5, and Non-Patent Document 6). However, in these documents, the subject to whom landiolol hydrochloride is administered is a patient at the time of surgery, not a patient who needs MSCT diagnosis. Moreover, in these documents, since landiolol hydrochloride is administered for the purpose of preventing or suppressing tachycardia at the time of surgery, the dose is a specific heart rate for patients who require MSCT diagnosis. There is no description or suggestion that it can be applied to adjust to the above. Furthermore, it was unclear whether the heart rate range after administration of landiolol hydrochloride disclosed in these documents is optimal for performing MSCT diagnosis.
Journal of Japanese Society of Medical Radiology, Vol. 53, No. 9, pp. 1033-1039, 1993 Emergency Medicine, 27, 719-725, 2003 European Journal of Clinical Pharmacology, 51, 467-471, 1997 Journal of Japanese Society of Clinical Anesthesia, 24, 10, 579-585, 2004 Anesthesia Analgesia, Vol. 98, pages 876-877, 2004 Contemporary medicine, Vol.36, No.1, pp.282-285, 2004 International Publication No. 2005/014042 Pamphlet Patent No. 2004651 Specification

  Compared to known diagnostic imaging aids, the burden on the patient (for example, medication compliance) is reduced, and clear images can be acquired for patients with high heart rate during non-operation (when MSCT is diagnosed) Development of a safe and clinically effective drug that reduces the heart rate and has the desired effect of improving the ability to depict coronary arteries has been desired.

  As a result of intensive studies to solve the above problems, the present inventors have obtained the following knowledge. That is, Patent Document 1 describes a method in which landiolol hydrochloride is rapidly administered intravenously and then continuously administered intravenously. Of the two administration steps of landiolol hydrochloride, an intravenous intravenous administration step is described. It has been found that the heart rate can be reduced by one time until a clear coronary artery image is obtained. Specifically, non-operative operation is achieved while reducing the burden on patients by performing only rapid intravenous administration of landiolol hydrochloride at a specific dose, and without causing side effects such as dizziness and lightheadedness, while ensuring safety. The present invention has been completed by finding that it can be effectively and simply reduced to a desired heart rate for a patient with a high heart rate at the time of diagnosis (at the time of MSCT diagnosis).

That is, the present invention
Item 1. In order to obtain a clear image in coronary image diagnosis by multi-slice helical CT, it is a diagnostic agent combined with a contrast agent. An imaging ability improving agent for intravenous administration of .05 mg to 2 mg of landiolol hydrochloride in 1 minute.
Item 2. A diagnostic agent in combination with a contrast agent, and in order to obtain a clear image in coronary artery image diagnosis by multi-slice helical CT, a patient having a heart rate of 65 times per minute during non-operation Item 2. The agent according to Item 1, wherein 0.05 mg to 2 mg of landiolol hydrochloride per kg of body weight is intravenously administered once in one administration step for 1 minute.
Item 3. Item 3. The agent according to Item 2, which is obtained by intravenously administering a contrast agent.
Item 4. Item 4. The agent according to Item 3, wherein the contrast agent is intravenously administered after 4 to 7 minutes.
Item 5. Item 3. The agent according to Item 2, wherein the dose per kg body weight of the patient is 0.05 mg to 0.5 mg.
Item 6. Item 6. The agent according to Item 5, wherein the dose per kg body weight of the patient is 0.075 mg, 0.125 mg, 0.25 mg or 0.5 mg.
Item 7. Item 6. The dose according to Item 5, wherein the dose per kg body weight of the patient is 0.06 mg.
Item 8. Item 7. The agent according to Item 6, wherein the dose per kg body weight of the patient is 0.125 mg.
Item 9. Item 7. The agent according to Item 6, wherein the dose per kg body weight of the patient is 0.25 mg.
Item 10. Item 7. The agent according to Item 6, wherein the dose per kg body weight of the patient is 0.5 mg.
Item 11. Item 2. The agent according to Item 1, wherein the contrast agent is a nonionic iodine-based contrast agent.
Item 12. Item 4. The agent according to Item 1, further comprising at least one selected from anesthetic anesthetics, muscle relaxants and anxiolytic agents.
Item 13. A diagnostic agent in combination with a nonionic iodine-based contrast agent, and a patient with a heart rate of 65 times or more per minute during non-operation in order to obtain a clear image in multi-slice helical CT image diagnosis of coronary arteries In contrast, 0.125 mg of landiolol hydrochloride per kg of the patient's body weight is intravenously administered once and for 1 minute, and after 4 to 7 minutes, a nonionic iodine-based contrast agent is intravenously administered. Imaging ability improving agent.
Item 14. A diagnostic agent in combination with a nonionic iodine-based contrast agent, and a patient with a heart rate of 65 times or more per minute during non-operation in order to obtain a clear image in multi-slice helical CT image diagnosis of coronary arteries On the other hand, 0.06 mg of landiolol hydrochloride per kg of the patient's body weight is intravenously administered once in one administration step for 1 minute, and nonionic iodine-based contrast agent is intravenously administered 4 to 7 minutes later. Imaging ability improving agent.
Item 15. In order to obtain a clear image in coronary imaging using a contrast agent by multi-slice helical CT, 0.05 mg to 2 mg of landiolol hydrochloride per kg of the patient's body weight was given to a patient with a high heart rate during non-operation. A method for improving visualization, which is administered intravenously over 1 minute.
Item 16. In order to obtain a clear image in coronary imaging using a contrast agent by multi-slice helical CT, 0.05 mg to 2 mg per kg of patient body weight is 1 minute for a patient with a high heart rate during non-operation. administered intravenously, for depiction performance improvement, hydrochloric Ranjio b Lumpur.
I will provide a.

  The present invention is a diagnostic agent in combination with a contrast agent, and in particular, for the purpose of obtaining a clear image in the coronary image diagnosis by MSCT, particularly in humans, not during surgery, that is, in coronary artery by MSCT. For patients undergoing diagnostic imaging and having a high heart rate, particularly those having a heart rate of 65 times or more per minute, an effective amount of said landiolol hydrochloride, preferably about 0.05 mg / kg of the patient's body weight Disclosed is an imaging performance-improving agent (hereinafter sometimes abbreviated as the agent of the present invention) in which ˜about 2 mg is administered intravenously once per administration step for 1 minute.

Landiolol hydrochloride In the present invention, landiolol hydrochloride means (-)-[(S) -2,2-dimethyl-1,3-dioxolan-4-yl] methyl-3- [4-[(S) -2- Hydroxy-3- (2-morpholinocarbonylamino) ethylamino] propoxy] phenylpropionic acid monohydrochloride, which has the following formula (I)

［式中、

[Where:

はβ−配置であることを表す。］で示される化合物である。

Represents a β-configuration. ].

  Landiolol hydrochloride is obtained by a method known per se, for example, the method described in Japanese Patent No. 2004651, Japanese Patent No. 3302647, a method analogous thereto, or Comprehensive Organic Transformations: A Guide to Functional Group Preparations, Second Edition (Richard C. Larock, John Wiley and Sons Inc, 1999) [Comprehensive Organic Transformations: A Guide to Functional Group Preparations, 2nd Edition (Richard C. Larock, John) Wiley & Sons Inc, 1999)] or by appropriately combining these methods. The product of the reaction is obtained by a conventional purification means such as distillation under normal pressure or reduced pressure, high performance liquid chromatography using silica gel or magnesium silicate, thin layer chromatography, column chromatography or washing, recrystallization, etc. Can be purified. Moreover, you may attach | subject to processes, such as freeze-drying, as desired.

  Landiolol hydrochloride used in the present invention is not limited to a substantially pure and single substance, but impurities, for example, by-products derived from the production process, solvents, raw materials, or decomposition products, It may be contained as long as it is acceptable as an active pharmaceutical ingredient. The content of impurities acceptable as an active pharmaceutical ingredient varies depending on the impurities contained, but for example, heavy metals are about 20 ppm or less, the total amount of impurities of related substances is less than 0.8% by mass, residual solvent such as acetone or Both ethyl acetate and the like are preferably 100 ppm or less.

Subject of Administration The subject of administration of the agent of the present invention is not particularly limited as long as it is a patient undergoing coronary artery image diagnosis by MSCT. Among them, a patient with a high heart rate is a suitable target. “Heart rate” in “a patient with a high heart rate”, that is, “a patient with a heart rate of 65 or more per minute” means non-operative, that is, at the time of MSCT diagnosis, more specifically, as shown in the examples described later. It means heart rate when entering the room.

  Usually, the heart rate of a patient at the time of MSCT imaging often increases more than usual. Although the heart rate increased from normal is 150 or less per minute, the heart rate when entering the laboratory of a patient to whom the agent of the present invention is administered is preferably 120 or less, more preferably 100 per minute. No more than 90 times, more preferably no more than 90 times per minute.

  In the agent of the present invention, the “patient with a high heart rate” means a patient with a heart rate that is so high that a clear image cannot be acquired in MSCT imaging. The “heart rate” of the “patient with a high heart rate” is preferably 65 times or more, more preferably 70 times or more per minute.

  In the agent of the present invention, “1 minute” may be strictly 1 minute or may include a deviation of about 30 seconds. That is, “1 minute” in the agent of the present invention is 31 seconds to 89 seconds, preferably 50 seconds to 70 seconds, and more preferably 60 seconds.

Dosage / Dose The agent of the present invention is administered in one step over 1 minute. In the agent of the present invention, the dose of landiolol hydrochloride is a dose that reduces the heart rate until it is possible to obtain a clear image in the coronary artery image diagnosis by MSCT without excessively reducing the heart rate of landiolol hydrochloride in the living body. Any dose, but preferably about 0.05 mg to about 2 mg per kg patient body weight, more preferably about 0.05 mg to about 0.5 mg per kg patient weight, even more preferably the patient From about 0.05 mg to about 0.25 mg per kg body weight, and even more preferably from about 0.05 mg to about 0.125 mg per kg patient body weight. Particularly preferred dosages are about 0.075 mg, about 0.125 mg, about 0.25 mg, or about 0.5 mg per kg patient body weight, and more preferred dosages are about 0.125 mg, about 0.25 mg per kg patient body weight, or About 0.5 mg, the most preferred dosage is about 0.125 mg / kg patient body weight. Also preferred is about 0.06 mg / kg patient body weight.

  Here, “reducing the heart rate without reducing the heart rate more than necessary and obtaining a clear image in coronary image diagnosis by MSCT” means, for example, that the patient does not cause serious side effects. Is preferably reduced to less than 65 times per minute, more preferably less than 60 times per minute.

  Serious side effects include excessive blood pressure reduction, cardiac arrest, shock, complete atrioventricular block, bradycardia, pulmonary artery pressure increase, asthma, hypoxemia, lightheadedness, dizziness, aspartate aminotransferase (AST) increase, It means alanine aminotransferase (ALT) elevation, total bilirubin elevation, leukocytosis, lactate dehydrogenase (LDH) elevation, etc., which are caused by excessively reducing heart rate. When lowering the heart rate, the lower limit is the above-mentioned heart rate without significant side effects, for example, 40 times or more per minute, preferably 45 times or more, more preferably 50 times or more per minute. . Further, the heart rate of the patient after the reduction is preferably about 45 or more and less than about 65 times per minute, and more preferably about 50 or more and less than about 60 times per minute.

  The present invention provides an effective amount of said landiolol hydrochloride, preferably about 0.05 mg to about 2 mg per kg patient body weight, more preferably about 0.05 mg to about 0.5 mg per kg patient weight, even more preferably About 0.05 mg to about 0.25 mg per kg patient weight, even more preferably about 0.05 mg to about 0.125 mg per kg patient weight, particularly preferably about 0.06 mg, about 0.075 mg, about 0.125 mg, about 0.25 mg. mg, or about 0.5 mg, more particularly preferably about 0.125 mg, in humans, especially patients undergoing non-operative, i.e., imaging of coronary arteries by MSCT, with high heart rate, preferably having a heart rate The present invention discloses an imaging performance improving agent that is administered intravenously in one administration step and one minute for a patient of 65 times or more per minute.

  In the agent of the present invention, “one administration step” means that the administration route, administration concentration, dosage and the like in one administration are determined to be one, and the number of administration is one. The agent of the present invention comprises only “high dose intravenous rapid administration” of “one administration step”, and “high dose intravenous rapid administration” and “low dose intravenous continuous administration” There is no need for intravenous administration consisting of two administration steps in combination.

Combination with a contrast agent The agent of the present invention is used in combination with a contrast agent. In that case, any combination method may be used. Examples include those containing landiolol hydrochloride and a contrast agent in the same pharmaceutical composition (so-called combination agents), those containing landiolol hydrochloride and a contrast agent in separate pharmaceutical compositions, and the like. In the method, it is preferable to contain landiolol hydrochloride and a contrast agent in separate pharmaceutical compositions. When the landiolol hydrochloride and the contrast agent are contained in separate pharmaceutical compositions, they may be administered simultaneously or at a time difference. When administering at a time difference, it is preferable to administer the pharmaceutical composition containing landiolol hydrochloride first and then administer the contrast agent. That is, the contrast agent may be administered after the patient's heart rate is reduced until a clear image can be obtained after administration of the pharmaceutical composition containing landiolol hydrochloride. Specifically, after administration of the pharmaceutical composition comprising landiolol hydrochloride, preferably between about 1 minute and about 10 minutes, more preferably between about 3 minutes and about 7 minutes, and even more preferably between about 4 minutes and about 7 minutes. A contrast agent may be administered. Here, “the patient's heart rate decreases until a clear image can be acquired” means, for example, that the patient's heart rate is preferably less than 65 times per minute, more preferably less than 60 times per minute, as described above. It means to reduce.

  When the contrast agent is contained in a separate pharmaceutical composition from landiolol hydrochloride, the contrast agent is preferably prepared and used in a dosage form that can be administered intravenously, such as an injection or an infusion preparation. Intravenous administration of the contrast agent may be administration using a syringe or administration by infusion, but the administration route is preferably the same as that of landiolol hydrochloride. By using the same administration route, it is not necessary to secure a plurality of intravenous administration routes, so that the burden on the patient can be reduced and the medication compliance can be improved.

  In the agent of the present invention, the “contrast agent” is not particularly limited. Iohexol, iomeprol, iopotate sodium, metrizoic acid, iodamide, iodoxamic acid, iodized poppy oil fatty acid ethyl ester, etc.), xenon-based contrast agents (for example, xenon gas, xenon injection solution, etc.), barium-based contrast agents (for example, , Barium sulfate, etc.), iron-based contrast agents (for example, fermoxides, ammonium iron citrate, etc.), gadolinium-based contrast agents (for example, gadopentetate meglumine, gadoteridol, etc.), and salts thereof. The contrast agent is preferably an iodine-based contrast agent.

  Examples of iodine-based contrast agents include nonionic iodine-based contrast agents and ionic iodine-based contrast agents. Examples of the nonionic iodine-based contrast agent include ioxirane, iotrolane, iopamidol, iopromide, iohexol, iomeprol and the like. Examples of the ionic iodine-based contrast agent include amidotrizoic acid, isoxaglic acid, iotalamic acid, iotroxic acid, iopanic acid, and salts thereof. The contrast agent used in the present invention is preferably a nonionic iodine-based contrast agent.

Image Diagnosis In the agent of the present invention, “image diagnosis of coronary arteries” includes, for example, image diagnosis for evaluating the lumen and walls of coronary arteries. Stenosis (presence / absence of stenosis, quantitative evaluation of stenosis, association with calcification of stenosis of coronary artery, evaluation of non-calcified plaque properties, evaluation of coronary stent restenosis, etc.), coronary aneurysm, abnormal running, etc. Using the same data, cardiovascular location, morphology, size assessment, heart morphology, wall motion and contraction, myocardial perfusion (contamination by contrast media), volume measurement (left) Evaluation of chamber diastole / systolic dose, left ventricular ejection fraction, myocardial weight), mural thrombus, etc. is also possible. The agent of the present invention can also be used when performing these diagnoses and evaluations.

  In the agent of the present invention, “multi-slice helical CT” means a helical CT having a multi-row detector and a plurality of simultaneous data acquisition systems, and includes multi-slice computed tomography (MSCT), multi-detector. Sometimes called CT (Multi detector computed tomography: MDCT), multi detector row computed tomography (CT), or the like.

  Examples of the tomography apparatus of MSCT include, for example, Aquilion (registered trademark) 64, Aquilion 32, Aquilion 16, Aquilion 8, Aquilion 4, Aquilion LB, Aquilion One (registered trademark), Aquilion / Multi, Ativion ( Activion (registered trademark) 16, Asteion (registered trademark), Asteon / Dual (manufactured by Toshiba Medical Systems), Brilliance CT64, Brilliance CT40, Brilliance CT16, Brilliance CT10, Brilliance CT6, MX8000, MX8000 IDT, MX8000D, MX8000 6slice, MX8000 dual, MX8000 quad, MX8000 IDT10, MX8000 IDT16 (Phillips Medical Stems), Zomatom Definition (SOMATOM Definition), Zomatom Definition AS, Zomatom Sensation Cardiac 64, Somatom Sensation 64-slice configuration, Zomatom Sensation 40-slice configuration, zomatom sensation 16, zomatom sensation 10, zomatom sensation open, zomatom emotion 16-slice configuration, zomatom emotion 6-slice configuration, zomatom spirit (SOMATOM Spirit), Volume Class / Sensation 4, Emotion Duo (from Siemens), ECLOS , ROBUSTO series (manufactured by Hitachi Medical Corporation), Light Speed VCT, Light Speed VCT Select, Light Speed Ultra 16, Light Speed Ultra, Light Speed Ultra With Extreme, Light Speed Ultra 16 With Extreme, light speed plus series, light speed Qx / i, high speed NX / i series, pro speed FII (manufactured by GE Yokogawa Medical System Co., Ltd.) and the like can be mentioned, but are not limited thereto.

  Examples of the number of detector columns provided in the tomography apparatus include 6, 8, 16, 32, 40, 64, 128, 256, and 320 columns.

Imaging Performance Improving Agent In the agent of the present invention, the “imaging performance improving agent” means an agent that reduces artifacts, particularly motion artifacts, generated when acquiring an image of a coronary artery by MSCT. Here, the “artifact” means a virtual image in the phase encoding direction that is artificially depicted on the image, and causes geometric distortion, non-uniform signal strength, and deterioration of image quality as a pseudo signal. . Causes of artifacts include body movement, blood / cerebrospinal fluid pulsation (flow), ferromagnet, chemical shift (chemical shift), and the like. “Motion artifact” means an artifact caused by body movement and blood pulsation (flow). Examples of the body motion include heartbeat and respiratory motion.

  In the agent of the present invention, the “clear image” means an optimal method (for example, a prospective ECG triggering reconstruction method, a retrospective ECG gating (gated) reconstruction method). ) Etc.) As shown in the examples described later, the images are classified into 15 segments based on the American Heart Association (AHA) coronary artery classification, and all coronary artery segments are targeted. As a result, when diagnosis is performed using an arbitrary multi-planar reformation (MPR) image, it means that there is no motion artifact or low, and diagnosis is possible. Here, “reconstructed in an optimal manner” means that, when an image is reconstructed, it is reconstructed so that motion artifacts are reduced most, as will be apparent to those skilled in the art.

Formulation Pharmaceutical compositions containing landiolol hydrochloride used in the agent of the present invention can be prepared by various methods as pharmaceutical compositions according to known methods, for example, the methods described in Japanese Patent No. 2004651 or Japanese Patent No. 3302647. It can be shaped. The dosage form may be any dosage form that can be administered intravenously, but in particular, a lyophilized preparation used by dissolving in a solution and a solvent at the time of use is preferred. These are injections. The liquid preparation is prepared by dissolving, suspending or emulsifying a component containing landiolol hydrochloride in a solvent. The lyophilized formulation is prepared by lyophilizing components containing landiolol hydrochloride in a vial.

  As the solvent, for example, distilled water for injection, physiological saline, vegetable oil, propylene glycol, polyethylene glycol, alcohols such as ethanol, and combinations thereof are used.

  In such a dosage form, preferred is a dosage form containing about 1 mg to about 1,000 mg of landiolol hydrochloride per unit form (eg, 1 ampoule, 1 vial, etc.). More preferably, the dosage form contains about 10 mg to about 100 mg, more preferably about 50 mg. In the case of a freeze-dried preparation, it is administered after being dissolved in an appropriate amount of physiological saline, water for injection or the like. Specifically, 1 vial (landiolol hydrochloride 50 mg) is dissolved in 5 mL of physiological saline, further diluted to a desired concentration, and then administered in a necessary amount based on the above dose range.

  Examples of those used in the pharmaceutical composition include commonly used stabilizers, solubilizers, suspending agents, emulsifiers, soothing agents, buffers, pH adjusters, and preservatives. , Isotonic agent and the like.

  Examples of the stabilizer include sodium citrate and sodium edetate. Examples of the solubilizer include glutamic acid, aspartic acid, polysorbate 80 (registered trademark), and the like. Examples of the suspending agent include surfactants such as stearyltriethanolamine, sodium lauryl sulfate, laurylaminopropionic acid, lecithin, benzalkonium chloride, benzethonium chloride, glyceryl monostearate, polyoxyethylene hydrogenated castor oil, polysorbate, etc. Agents, polyhydric alcohols such as glycerin and macrogol, saccharides such as sorbitol, mannitol, sucrose, celluloses such as methylcellulose, carboxymethylcellulose, hydroxypropylmethylcellulose, polyvinyl alcohol, polyvinylpyrrolidone, carboxyvinyl polymer, sodium carboxymethylcellulose, methylcellulose , Hydrophilic polymers such as hydroxymethylcellulose, hydroxyethylcellulose, hydroxypropylcellulose, Chondroitin sulfate, etc., and the like. Examples of the emulsifier include glycerin ester, saponin (for example, Enjusaponin, Quillaja extract, soybean saponin, etc.), sucrose fatty acid ester (for example, sucrose ester, etc.), lecithin (for example, plant lecithin, egg yolk lecithin) and the like. Can be mentioned. Examples of soothing agents include benzyl alcohol, chlorobutanol, propylene glycol, ethyl aminobenzoate, lidocaine and the like. Examples of the buffer include phosphates (eg, sodium hydrogen phosphate, sodium dihydrogen phosphate), boric acid, borax, acetates (eg, sodium acetate), carbonates (eg, sodium carbonate, Calcium carbonate, potassium carbonate, etc.), citric acid, sodium L-glutamate and the like. Examples of the pH adjuster include sodium hydroxide, potassium hydroxide, trisodium phosphate, disodium hydrogen phosphate, hydrochloric acid, nitric acid, citric acid, boric acid, acetic acid and the like. Examples of preservatives include parabens such as propyl paraoxybenzoate and butyl paraoxybenzoate, methylparaben, ethylparaben, benzalkonium chloride, benzethonium chloride, chlorhexidine gluconate, cetylpyridinium chloride and other soaps, chloro Examples include alcohol derivatives such as butanol, benzyl alcohol, and phenethyl alcohol, organic acids such as sodium dehydroacetate, sorbic acid, and sodium sorbate, and salts thereof, and phenols such as parachloromethoxyphenol and parachlorometacresol. Examples of the isotonic agent include glucose, D-sorbitol, sodium chloride, glycerin, concentrated glycerin, D-mannitol, potassium chloride, propylene glycol, and sucrose.

  The pharmaceutical composition is sterilized in the final step or manufactured by an aseptic operation. In addition, a sterile solid preparation such as a freeze-dried preparation can be produced and used by dissolving it in sterilized or sterile distilled water for injection, physiological saline or other solvent before use.

  As a specific preparation of a pharmaceutical composition containing landiolol hydrochloride, for example, ONOACT 50 (ONOACT: registered trademark) for injection can be mentioned, and the preparation is sold by Ono Pharmaceutical Co., Ltd.

Concomitant drugs The agents of the present invention can be used in combination with other drugs such as muscle relaxants, anxiolytics, anesthetic aids, nitrates and the like as desired. These concomitant drugs may be administered simultaneously with the agent of the present invention, or may be administered with a time difference. Preferably, these concomitant drugs are administered first, and then the agent of the present invention is administered.

  Examples of the muscle relaxant that can be used in combination with the agent of the present invention include A-type botulinum toxin, papaverine hydrochloride, dantrium, dantrolene sodium, vecuronium bromide, pancuronium bromide, and squismethonium chloride.

  Examples of the anti-anxiety drugs that can be used in combination with the agent of the present invention include diazepam, oxazolam, flutazolam, alprazolam, ethyl loflazepate, tofisobam, etizolam, bromazepam, clothiazepam, lorazepam and the like.

  Examples of the anesthetic adjuvant that can be used in combination with the agent of the present invention include pethidine, fentanyl, dromolan and the like.

  Nitric acid drugs that can be used in combination with the agent of the present invention include, for example, nitroglycerin, amyl nitrite, isosorbide nitrate and the like.

Toxic landiolol hydrochloride is a drug already used clinically and has been confirmed to be safe. Moreover, it can be judged that the usage and dosage of the present invention are sufficiently safe when used for mammals, particularly humans. In clinical trials, it has been confirmed that about 2 mg of landiolol hydrochloride per kg of the patient's body weight is intravenously administered once in the administration step for about 1 minute.

Application to pharmaceuticals The agent of the present invention for intravenous administration of about 0.05 mg to about 2 mg of landiolol hydrochloride per kg of body weight of a patient in one administration step and about 1 minute in combination with a contrast agent is particularly a coronary artery by MSCT. It is possible to obtain a clear image of the coronary artery by administering it to a patient in need of diagnostic imaging.

  When administering the agent of the present invention to a patient undergoing coronary artery imaging diagnosis by MSCT, a pharmaceutical composition containing landiolol hydrochloride and a contrast agent are used separately, or a pharmaceutical composition containing both landiolol hydrochloride and a contrast agent. Things are used. In the agent of the present invention, it is preferable to separately use a pharmaceutical composition containing landiolol hydrochloride and a contrast agent. In this case, it is desirable to administer the contrast agent about 4 minutes to about 7 minutes after the administration of the pharmaceutical composition containing landiolol hydrochloride is completed.

  In image diagnosis such as MSCT, the heart rate of a patient can be effectively reduced by using the agent of the present invention. While some patients have high heart rates due to tension during MSCT examinations, the agents of the present invention can reduce the heart rate of such patients to an optimal range, among others, resulting in motion artifacts. A few clear coronary artery images can be obtained. Conventionally, landiolol hydrochloride has been continuously administered intravenously after rapid intravenous administration. However, in the present invention, only rapid intravenous administration is performed, which facilitates administration work and improves medication compliance. This reduces the burden on patients. Furthermore, it is safe without side effects such as dizziness and light-headedness even though only intravenous rapid administration is performed.

Hydrochloride Ranjio b Lumpur 0.125 mg / kg administered group (L group), 0.25 mg / kg administered group (M group), 0.5 mg / mg dose group heart rate (H group) (average value of the representative Example 3 Example) FIG.

  Hereinafter, the clinical effect when the agent of the present invention is administered to a patient in need of image diagnosis of coronary artery by MSCT will be described in detail with reference to examples and formulation examples, but the present invention is not limited thereto. Absent. Further, the administration method and the dosage may be changed without departing from the scope of the present invention.

Example 1: (Drawing ability improvement effect)
As a clinical study, multicenter among 3 groups of 0.125 mg / kg administration group (group L), 0.25 mg / kg administration group (group M) and 0.5 mg / kg administration group (group H) of landiolol hydrochloride as the test drug Conducted in a joint open-label study.

[Target]
Patients who are suspected of ischemic heart disease by symptom, physical findings and non-invasive examination and who require coronary angiography, meet the following selection criteria and do not meet the following exclusion criteria.

<Selection criteria>
1) 20 to 74 years old (when consent is obtained)
2) Gender: Any
3) Hospitalization / Outpatient: Any
4) Ischemic heart disease is suspected by listening to symptoms, physical examination, standard 12-lead ECG, chest X-ray examination, or echocardiography, and either (1) or (2) below (1) Patients with subjective symptoms of chest pain and positive electrocardiogram (2) Patients with positive myocardial perfusion image or echocardiography
5) Patients who have a heart rate of 70 times / min or more and 90 times / min or less when entering the laboratory

<Exclusion criteria>
1) Patients with atrial fibrillation or patients with ventricular extrasystole 1/5 sec or more
2) Patients with cardiogenic shock
3) Patients with diabetic ketoacidosis or metabolic acidosis
4) Severe heart failure patients (New York Heart Association (NYHA) heart function classification III degrees or higher)
5) Atrioventricular block patients with degree II or higher
6) Patients with bradyarrhythmia such as sick sinus syndrome (including pacemaker implantation cases)
7) Patients with right heart failure due to pulmonary hypertension
8) Patients with and suspected pheochromocytoma
9) Patients with bronchial asthma
10) Patients with a history of hypersensitivity to iodine or iodine-based contrast media
11) Patients with severe thyroid disease
12) Patients with acute pancreatitis, macroglobulinemia, multiple myeloma, or tetany
13) Extremely bad patients with general condition
14) Patients undergoing dialysis or patients with serum creatinine of 1.5 mg / dL or more
15) Patients with total bilirubin of 3.0 mg / dL or higher, or aspartate aminotransferase (AST) and alanine aminotransferase (ALT) of 2.5 times or more (or 100 IU / L or higher) of the facility normal value
16） Patients with severe allergies
17) Patients who are pregnant, breastfeeding, who may be pregnant, or who wish to become pregnant during the study period
18) Patients who have not passed 4 months after administration of all other study drugs (at the start of administration)
19) Other patients who are judged to be inappropriate for the study by the investigator etc. For 1), 14) and 15), the latest test values measured within 30 days before study drug administration should be used. It was.

<Dosage and administration and administration period>
As shown in Table 1 below, a vial containing 50 mg of the test drug in one vial and a placebo vial not containing the test drug were combined, and a total of 4 vials were dissolved in 20 mL of physiological saline for dissolving the test drug. The amount necessary for the patient to be administered was prepared as 0.05 mL per 1 kg body weight, and further, physiological saline was added to make a total volume of 10 mL, and then the solution was intravenously administered over about 50 seconds. Subsequently, 2 to 5 mL of physiological saline was intravenously administered over about 10 seconds, and the drug solution administration time was about 1 minute in total. Three to seven minutes after the end of the administration of the drug solution, coronary artery CT imaging by MSCT was taken.

<Pretreatment and combination therapy>
1) Drugs (1) to (6) below use (combination) prohibited drugs have a washout period of at least twice the half-life of the drug from the last use time to the start of test drug administration. The combined use was prohibited until the observation was completed 30 minutes after the start of study drug administration.
(1) β-blocker (2) Ca antagonist (eg, diltiazem hydrochloride, verapamil hydrochloride, bepridil hydrochloride)
(3) Antiarrhythmic drugs (4) Sympathomimetic drugs (5) Biguanide diabetics (eg, metformin hydrochloride, buformin hydrochloride)
(6) All investigational drugs that are currently under development and have not been determined
2) Use (combination) banned therapy From the morning of the day of the multi-slice CT examination until the end of the examination, therapies that affect the heart rate (such as pacing) will not be implemented.

<About coronary artery CT imaging by MSCT>
Coronary artery CT imaging was performed according to the following (1) to (3). As a measuring instrument, Sensation Cardiac 64 or SOMATOM Sensation 64 of SIEMENS was used.
(1) Contrast agent • A nonionic iodine-based contrast agent was used, and the contrast agent concentration was adjusted so that the iodine amount per mL was 350 to 370 mg.
-Following administration of the test drug, the contrast agent dose was rapidly administered intravenously at 3 to 4.5 mL / second, and 20 to 30 mL of physiological saline was boosted at 3 to 4.5 mL / second.
(2) MSCT imaging protocol • Tube voltage (kV): 120
Tube current (mAs / slice): 770-850
-Collimation (row x mm): 32 x 0.6
・ X-ray tube rotation time (sec / rot): 0.33
-Reconstructed slice thickness (mm): 0.75
・ Helical pitch: 0.2
(3) MSCT imaging procedure
1． Enter the examination room
2． ECG monitor electrode, Holter monitor electrode and blood pressure monitor installed
3． Securing of blood vessels (contrast medium administration line: elbow vein)
Four. Nitric acid (spray) administration
Five. Administration of landiolol hydrochloride for about 1 minute (under ECG and blood pressure monitoring)
6． Simple CT imaging (imaging position adjustment)
7． Contrast agent administration (bolus tracking): MSCT imaging ^*
8． Indwelling needle removal, ECG electrode removal
9． Leave the examination room
Ten. Observation of heart rate and blood pressure 15 and 30 minutes after the end of administration *: Since the proximal part was regarded as important, imaging was performed from the base of the heart to the apex.
Based on the image data, the image was reconstructed by a retrospective ECG gated reconstruction method (retrospective ECG gated reconstruction method).

<Effectiveness evaluation items>
[Evaluation item]
1) Average heart rate converted from electrocardiogram records (approximately 10-15 seconds) during coronary CT imaging
2) Volume rendering (VR) images and MPR images (curved arbitrary multi-section reconstructed (curved MPR) images and orthogonal cross-section images) were created based on the reconstructed images of coronary artery rendering ability. With reference to the VR image, the images were classified into 15 segments according to the AHA coronary artery classification. However, for segment 4, the atrioventricular branch was # 4AV, and the posterior descending branch was # 4PD. For all coronary artery segments, the coronary artery rendering ability was evaluated using MPR images. However, coronary artery segments with high calcification, stent placement, poor contrast (stenosis, etc.), or adjacent structures were excluded from the evaluation.
The segment to be evaluated was determined in the following three stages.
3． Diagnosis is possible without artifacts (no motion artifacts, diagnostic images)
2． Diagnosis is possible with artifacts (images with motion artifacts and diagnoses)
1． Diagnosis is impossible due to artifacts (images with motion artifacts and cannot be diagnosed)
Among the evaluated segments, the lowest score was used as the score of the patient, and the ratio of scores of 2 or more in each group, that is, the ratio at which the degree of coronary artery stenosis can be diagnosed was evaluated.

<Safety evaluation items>
The following items were observed and examined.
1) Blood pressure (systolic blood pressure / diastolic blood pressure)
Implementation method: Measurements were taken at each time point.
Measurement time: Before the start of the test, when entering the laboratory, before administration of landiolol hydrochloride, at the end of administration of landiolol hydrochloride, 1 minute, 2 minutes, 3 minutes, 4 minutes, 5 minutes, 6 minutes, 7 minutes later 8 minutes, 9 minutes later, 10 minutes later, 15 minutes later, 30 minutes later.
2) Transcutaneous oxygen saturation (SpO ₂ )
Implementation method: Percutaneous oxygen saturation was continuously monitored and recorded at each time point.
Measurement time: When entering the laboratory, before administration of landiolol hydrochloride, at the end of administration of landiolol hydrochloride, 1 minute, 2 minutes, 3 minutes, 4 minutes, 5 minutes, 6 minutes, 7 minutes, 8 minutes later 9 minutes later, 10 minutes later, 15 minutes later, 30 minutes later.
3) Method for performing electrocardiogram examination: An electrocardiogram record including at least the second (or V5) lead was recorded at the following measurement points. The recording speed was 25 mm / second. RR interval, PQ time, QRS width, QT time, and ST portion were measured.
Measurement time: (1) 12-lead ECG: before the start of the test, twice within 3 days after administration of landiolol hydrochloride, (2) Holter ECG: before administration of landiolol hydrochloride, at the end of administration of landiolol hydrochloride, 1 minute, 2 minutes later 3 minutes later, 4 minutes later, 5 minutes later, 6 minutes later, 7 minutes later, 8 minutes later, 9 minutes later, 10 minutes later, 15 minutes later, 30 minutes later.
4) General clinical examination / implementation method: Hematological examination (white blood cell count, white blood cell classification, red blood cell count, hemoglobin concentration, hematocrit value, platelet count), blood biochemical test (total protein, albumin, blood urea nitrogen (BUN) ), Uric acid, creatinine, total bilirubin, aspartate aminotransferase (AST), alanine transferase (ALT), γ-GTP, lactate dehydrogenase (LDH), alkaline phosphatase (ALP), creatinine phosphokinase (CK), total Cholesterol, electrolytes (Na, K, Cl)) were performed.
-Implementation period: Within 30 days before administration of landiolol hydrochloride and within 3 days of termination (discontinuation) of landiolol hydrochloride.
5) Adverse events Regarding adverse events that occurred after the start of administration of landiolol hydrochloride (general clinical examination conducted from the end of administration to 3 days after the end of administration), symptoms, onset date, degree, severity, administration of landiolol hydrochloride The presence or absence of continuation, the presence or absence of treatment, the causal relationship with landiolol hydrochloride, and the course (when recovered, the date of recovery) were investigated.

[Grades]
The results are shown below.
<Effectiveness evaluation items>
When the test drug is not administered, the score of the patient is 1, and the proportion of the score of 1 that cannot be diagnosed is large in each segment. On the other hand, the coronary arteries rendering ability was improved in each of the L group, the M group, and the H group, and a diagnosable image could be obtained. The representative examples in each group are shown below.

  As shown in Table 2, the heart rate was reduced to less than 65 times per minute at the time of multi-slice helical CT (MSCT in the table) at any dose, and there was no patient whose heart rate was reduced enough to have side effects. As shown in Table 3, the score of coronary artery rendering ability was also 2 or more in each segment, and a diagnostic image could be obtained. From this, it was found that the administration of the agent of the present invention reduces the patient's heart rate to the extent that no side effects are involved, and an image that can be stably diagnosed can be obtained.

  In each of the L group, the M group, and the H group, the heart rate that had increased before the test began to decrease immediately after the administration of the test drug, and a clear image even after 10 minutes had elapsed after the administration. It was found that the heart rate was suppressed to such an extent that it was possible to obtain. FIG. 1 shows changes in heart rate of each group (changes in average values of heart rates of three representative examples). As shown in FIG. 1, the test drug is intravenously administered once in one administration step for 1 minute, thereby completing the time required for the end of coronary imaging by MSCT, that is, the administration of the agent of the present invention. It has been found that the patient's heart rate is reduced to such an extent that a clear image can be acquired for 1 to 10 minutes.

  Furthermore, when the results of this clinical study are summarized, the rate of score 2 or higher increases with a decrease in the heart rate at the time of radiography, and between the heart rate at the time of radiography and the ability to visualize coronary arteries in each case, blood vessel, and segment. Was confirmed to have a certain correlation. The percentage of each group with a score of 2 or more was 46.2% in the L group, 50.0% in the M group, and 40.7% in the H group for each case. It was. In addition, heart rate in group L is 76.2 ± 12.1 times / minute when entering the examination room to 63.9 ± 7.8 times / minute when photographing, and group M is 75.8 ± 9.2 times / minute when entering the examination room and 64.0 ± 8.1 times / minute when photographing. In the H group, the heart rate was reduced from 80.1 ± 11.0 times / minute to 62.8 ± 9.4 times / minute when entering the laboratory, to less than 65 times per minute in each group.

<Safety evaluation items>
The incidence of adverse events was 6.7% in the L group, 6.7% in the M group, and 3.3% in the H group, and there were no serious adverse events. From this, it was found that all of the L group, the M group, and the H group are safe administration methods and safe dosages. The heart rate recovered to normal after 30 minutes, that is, to the same level as before the start of the test. From this, it was found that it is not necessary to restrain the patient for a long time after the examination and observe the progress.

  From the above results, patients with high heart rate at the time of MSCT diagnosis can be given to patients undergoing diagnostic imaging of coronary arteries by MSCT by performing only one rapid intravenous administration of landiolol hydrochloride at a specific dose. On the other hand, the burden on the patient (for example, medication compliance, etc.) is reduced, the heart rate is reduced until a clear image can be acquired while ensuring safety, and the desired coronary artery visualization ability is improved. It has been shown.

Example 2: (Drawing ability improvement effect)
In clinical trials, coronary angiography by MSCT was compared with the placebo group for the efficacy and safety of the test drug landiolol hydrochloride 0.06 mg / kg (LL group) and 0.125 mg / kg (L group) It was carried out by the method according to Example 1 by the multicenter double-blind randomized parallel group comparison test.

[Target]
Patients who are suspected of ischemic heart disease due to symptoms, physical findings and non-invasive examination and who require coronary angiography (CAG), meet the following selection criteria and do not meet the above exclusion criteria.
<Selection criteria>
1) 20 years old and over (at the time of obtaining consent)
2) Gender: Any
3) Hospitalization / Outpatient: Any
4) Before coronary artery CT angiography, ischemic heart disease was suspected by any of the following: (listening of symptoms by medical examination, physical examination, standard 12-lead ECG, chest X-ray examination and echocardiography) Patients who satisfy either 1) or (2) (1) Patients who have subjective symptoms of chest pain and are positive for exercise ECG (2) Patients who are positive for stress myocardial blood flow image or stress echocardiography
5) Patients who will undergo coronary angiography after coronary CT
6) Patients who have a heart rate of 70 times / min or more and 90 times / min or less when entering the laboratory and immediately before administration of nitrate

<Dosage and administration and administration period>
After administration of nitrate drug (spray) and before the contrast time of coronary CT imaging, as shown in Table 4 below, a vial containing 50 mg of the test drug in one vial and a placebo vial not containing the test drug were combined and totaled Two vials were dissolved in 40 mL of physiological saline for dissolving the test drug. 0.05 mL of 1 kg body weight was taken from the dissolved solution, and physiological saline was added to make a total volume of 10 mL. The prepared solution was intravenously administered over about 50 seconds, and the test drug remaining in the administration line was slowly flushed with 2-5 mL of physiological saline for about 10 seconds. The total administration time from the start of test drug administration to the end of flushing was not allowed to exceed 80 seconds. In addition, the test drug was administered after 5 minutes or more after the administration of the nitrate drug (spray).

<About coronary artery CT imaging by MSCT>
Coronary artery CT imaging was performed according to the following (1) to (3). The measuring instruments used were Sensation Cardiac 64, SOMATOM Sensation 64 and SOMATOM Sensation 64-Slice configuration from SIEMENS. Coronary artery CT imaging was performed between about 240 seconds to about 420 seconds (about 4 to about 7 minutes) after the end of administration, with the test drug administration end time being zero.

(1) Contrast agent • A non-ionic iodine-based contrast agent (for example, iopamidol) was used, and the contrast agent concentration was adjusted so that the amount of iodine per mL was 370 mg.
-Following administration of the test drug, the contrast agent dose was rapidly administered intravenously at 3 to 4.5 mL / second, and 20 to 30 mL of physiological saline was flushed at 3.5 to 4.5 mL / second.
・ The total dose of contrast medium was 1 mL / kg body weight.
(2) MSCT imaging protocol • Tube voltage (kV): 120
Tube current (mAs / slice): 770-850
-Collimation (row x mm): 32 x 0.6
・ X-ray tube rotation time (sec / rot): 0.33
-Reconstructed slice thickness (mm): 0.75
・ Helical pitch: 0.2 or less
(3) MSCT imaging procedure
1． Enter the examination room
2． ECG monitor electrode, Holter monitor electrode and blood pressure monitor installed
3． Securing of blood vessels (contrast medium administration line: elbow vein)
Four. Nitric acid (spray) administration ^*
Five. Administration of landiolol hydrochloride for about 1 minute (under ECG and blood pressure monitoring)
6． Simple CT imaging (imaging position adjustment)
7． Contrast agent administration (bolus tracking): MSCT imaging ^*
8． Indwelling needle removal, ECG monitor electrode removal
9． Observation of heart rate and blood pressure 15 and 30 minutes after administration
Ten. Laboratory exit *: It was confirmed that the heart rate at rest was about 70 times / min and about 90 times / min both after entering the laboratory and immediately before the administration of nitrate (spray).
**: Coronary CT was performed from the base of the heart to the apex to emphasize the proximal part.
Based on the image data, the image was reconstructed by a retrospective ECG gated reconstruction method (retrospective ECG gated reconstruction method).

<Effectiveness evaluation items>
[Main evaluation items]
1) Coronary artery rendering ability (i) Image reconstructed using 70% of RR interval as a trigger, or (ii) Volume rendering (VR) image and arbitrary multiple images based on an image reconstructed by an optimal method A cross-sectional reconstruction (MPR: multi-planar reformation) image (curved MPR (curved MPR) image and orthogonal cross-sectional image) was created. With reference to the VR image, the images were classified into 15 segments according to the AHA coronary artery classification. However, for segment 4, the atrioventricular branch was # 4AV, and the posterior descending branch was # 4PD. For all coronary artery segments, the coronary artery rendering ability was evaluated using MPR images. The coronary articulation ability uses the image of (i), except for banding artifacts (one of the motion artifacts, a band-like shift of an image that appears periodically with a certain thickness that may be considered a factor other than heart rate) In addition to the determination in the following three stages, the case where banding artifacts were included was also evaluated. For reference, the image (ii) was also evaluated in the same procedure. However, coronary artery segments with high calcification, stent placement, poor contrast (stenosis, etc.), or adjacent structures were excluded from the evaluation.
3． Diagnosis is possible without artifacts (no motion artifacts, diagnostic images)
2． Diagnosis is possible with artifacts (images with motion artifacts and diagnoses)
1． Diagnosis is impossible due to artifacts (images with motion artifacts and cannot be diagnosed)
Among the evaluated segments, the lowest score was used as the score of the patient, and the ratio of scores of 2 or more in each group, that is, the ratio at which the degree of coronary artery stenosis can be diagnosed was evaluated.

[Secondary evaluation items]
1) Coronary artery diagnostic ability (sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy)
Diagnosis ability (sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy) from the coincidence of the presence or absence of significant stenosis on CAG and the presence or absence of significant stenosis (stenosis with stenosis rate of 50% or more) on coronary CT ) Was calculated.
2) Heart rate at the time of coronary CT imaging, rate of slowing, heart rate at each measurement point The average heart rate was converted from the electrocardiogram recording at the time of coronary CT imaging, and the following items were calculated for each administration group.
(I) Summary statistic of heart rate at the time of coronary CT imaging (ii) Summary statistic of bradycardia rate relative to heart rate before administration of test drug (iii) The number of heart rate is a threshold (70, 65, 60 / Min)
For patients undergoing imaging of coronary artery by MSCT, only one rapid intravenous administration of landiolol hydrochloride at a specific dose (LL group, L group) gives a high heart rate at the time of MSCT diagnosis As in Example 1, the burden on the patient (for example, medication compliance) is reduced for the patient, and the heart rate is reduced until a clear image can be acquired while ensuring safety, and desired. It was shown that it has the effect of improving the ability to depict coronary arteries.

  In the present invention, any of the embodiments is preferable. In particular, for a patient who undergoes coronary imaging diagnosis by MSCT and whose heart rate is 65 times or more per minute, 0.125 mg / kg of the patient's body weight Most preferred is an embodiment in which landiolol hydrochloride is intravenously administered once in one administration step for 1 minute, and a nonionic iodine-based contrast agent is intravenously administered 4 to 7 minutes later.

Formulation Example 1: Production of freeze-dried preparation containing 50 mg of landiolol hydrochloride The following components were mixed by a conventional method, then the solution was sterilized by a conventional method, filled in 0.6 mL vials, freeze-dried by a conventional method, 1 vial Ten thousand vials containing 50 mg of active ingredient in were obtained.
・ Landiolol hydrochloride ・ 750g
・ D-mannitol ・ ・ ・ ・ ・ ・ 750g
・ Sodium hydroxide ... 630mg
・ Distilled water ・ ・ ・ ・ 9000mL

  The agent of the present invention can effectively and easily depict coronary arteries by MSCT while maintaining patient safety by being administered to patients who need image diagnosis of coronary arteries by MSCT, especially those with high heart rate. Improves and makes it possible to obtain a clear image.

Claims (4)

In order to obtain a clear image in coronary imaging using multi-slice helical CT, the patient's body weight was determined for patients who had a heart rate of 70 to 90 times per minute during non-operation. An agent for improving the visualization ability, wherein 0.125 mg of landiolol hydrochloride per kg is intravenously administered once per administration step for 1 minute, and the heart rate of the patient is reduced to 50 times or more and less than 65 times per minute . The agent according to claim 1, which is then intravenously administered with a contrast agent. The agent according to claim 2 , wherein the contrast agent is intravenously administered after 4 to 7 minutes. The agent according to any one of claims 1 to 3, further comprising at least one selected from an anesthetic adjuvant, a muscle relaxant and an anxiolytic drug.

Images