A comparative study of ivabradine and atenolol in patients with moderate mitral stenosis in sinus rhythm

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• 作者：Gopalan Nair Rajesh^a ; ^{drrajeshgnair@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Kalathingathodika Sajeer^b ; Chakanalil Govindan Sajeev^c ; Cicy Bastian^a ; Desabandhu Vinayakumar^a ; Kader Muneer^d ; Vellani Haridasan^e ; Dolly Mathew^e ; Biju George^g ; Mangalath Narayanan Krishnan^f
• 关键词：Exercise ; Mitral stenosis ; Tachycardia ; Rate control
• 刊名：Indian Heart Journal
• 出版年：2016
• 出版时间：May-June 2016
• 年：2016
• 卷：68
• 期：3
• 页码：311-315
• 全文大小：543 K

文摘

Beta-blockers are frequently used in patients with mitral stenosis to control the heart rate and alleviate exercise-related symptoms. The objective of our study was to examine whether ivabradine was superior to atenolol for achieving higher exercise capacity in patients with moderate mitral stenosis in sinus rhythm. We also evaluated their effects on left ventricular myocardial performance index (MPI).

Methods and results

Eighty-two patients with moderate mitral stenosis in sinus rhythm were randomized to receive ivabradine (n = 42) 5 mg twice daily or atenolol (n = 40) 50 mg daily for 6 weeks. Transthoracic echocardiography and treadmill test were performed at baseline and after completion of 6 weeks of treatment. Mean total exercise duration in seconds markedly improved in both study groups at 6 weeks (298.57 ± 99.05 s vs. 349.12 ± 103.53 s; p = 0.0001 in ivabradine group, 290.90 ± 92.42 s vs. 339.90 ± 99.84 s; p = 0.0001 in atenolol group). On head-to-head comparison, there was no significant change in improvement of exercise time between ivabradine and atenolol group (p = 0.847). Left ventricular MPI did not show any significant change from baseline and at 6 weeks in both drug groups (49.8% ± 8% vs. 48.3% ± 7% in ivabradine group, 52.9% ± 10% vs. 50.9% ± 10% in atenolol groups; p = 0.602).

Conclusion

Ivabradine or atenolol can be used for heart rate control in patients with moderate mitral stenosis in sinus rhythm. Ivabradine is not superior to atenolol for controlling heart rate or exercise capacity. Left ventricular MPI was unaffected by either of the drugs.