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Ivabradine is More Potent than Metoprolol in Improving Hemodynamic Parameters

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Ivabradine is More Potent Than Metoprolol in Improving Hemodynamic Parameters in the Patients with Mild to Moderate Mitral Stenosis

Background Information

Mitral stenosis is a valvular heart disease which is characterized by the narrowing of the orifice of the mitral valve of the heart. It is studied both at rest and during exercise. Transmitral gradient increase with the heart rate during exercise results in elevated pulmonary venous pressure, precipitating dyspnea. Beta-blockers have been shown to improve clinical and hemodynamic profile significantly in the symptomatic patients. The novel rate-lowering drug ivabradine results in a dose-dependent heart reduction at rest and during exercise.

Ivabradine belongs to a miscellaneous cardiovascular agent. It has been used for the treatment of chronic stable angina pectoris in patients with normal sinus rhythm. At present, it is recommended in the treatment of heart failure where the heart rate remains more than 70 beats per minute despite beta-blockers.

Metoprolol is used to treat angina and hypertension. It also used to treat or prevent heart attack. It is contraindicated in the patients who had serious heart problem and severe blood circulation problems.

Objective of the Study

The main objective of the study was to evaluate the effects of ivabradine and metoprolol on hemodynamic parameters and effort intolerance in patients with mitral stenosis and normal sinus rhythm and to compare the effects of ivabradine and metoprolol.

Methods and Materials:

Protocol

The study design was approved by institutional review board. All the patients were asked to sign the written informed consent for the study.

Sample Size

A total of 34 patients were selected for the study.

Inclusion Criteria

The patients who had mild to moderate mitral stenosis were included in the study.

Exclusion Criteria

Patients with acute decompensated heart failure, ischemic heart disease, congenital heart disease, class 3 or higher chronic obstructive pulmonary disease were excluded from the study.

Statistical Analysis

Paired t test was used for statistical analysis.

Study Procedure

The patients were divided into two groups. Group A was assigned to ivabradine 5 mg twice daily over two weeks, increased to maximum dose of 10 mg twice daily over two weeks, and then continued for four weeks. Group B was assigned to metoprolol 50 mg twice daily over two weeks, increased to a maximum dosage 100 mg twice daily over two weeks and continued for next four weeks. A repeat clinical evaluation, exercise stress test and 2D and Doppler ECHO were performed at the end of six weeks.

Results

Baseline and Exercise Parameters in Both Group

There was a significant decrease in heart rate at resting, increase in heart rate while doing exercise, and decrease in mean gradient across mitral valve and pulmonary artery systolic pressure. Total exercise duration after both ivabradine and metoprolol therapy was statistically significant but to a similar extent.

There was a significant decrease in heart rate at resting, increase in heart rate while doing exercise, and decrease in mean gradient across mitral valve and pulmonary artery systolic pressure. Total exercise duration after both ivabradine and metoprolol therapy was statistically significant but to a similar extent.

Conclusion

Ivabradine and metoprolol had beneficial effects in the patients with mild-moderate mitral stenosis and normal sinus rhythm. The study proved that ivabradine was more potential than metoprolol regarding the improvement in symptomatic status, exercise parameters, and hemodynamic parameters.

Reference

Saggu DK, et al. Effect of Ivabradine on Heart Rate and Duration of Exercise in Patients with Mild-to-Moderate Mitral Stenosis: A Randomized Comparison with Metoprolol. J Cardiovasc Pharmacol. 2015 Jun; 65 (6):552-4

Available at: http://www.ncbi.nlm.nih.gov/pubmed/25636072/

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