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Ramos JDA, Cunanan EL, Abrahan LL, Tiongson MDA, Punzalan FER. Ivabradine Versus Beta-Blockers in Mitral Stenosis in Sinus Rhythm: An Updated Meta-Analysis of Randomized Controlled Trials. Cardiol Res 2018; 9:224-230. [PMID: 30116450 PMCID: PMC6089474 DOI: 10.14740/cr737w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/12/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Symptoms of mitral stenosis (MS) are worsened during tachycardia and exercise. Beta-blockers are used in controlling heart rate (HR) in MS, resulting in symptom improvement, but coming with significant side effects. Ivabradine has a selective action on the sinus node devoid of the usual side effects of beta-blockers. Small studies have recently investigated the role of ivabradine in MS in sinus rhythm. Our aim was to determine the efficacy of ivabradine, compared to beta-blockers, in terms of exercise duration, maximum HR achieved, resting HR, mean gradient, and working capacity among patients with MS in sinus rhythm. METHODS We conducted a systematic search of studies using MEDLINE, Google Scholar, ScienceDirect, Scopus, Clinical Key, Cochrane, and clinicaltrials.gov databases in all languages and examined reference lists of studies. We included studies if they are: 1) randomized controlled trials comparing ivabradine and beta-blockers; 2) of adults ≥ 19 years old with MS in sinus rhythm; and 3) reported data on exercise duration, maximum HR achieved, resting HR, mean gradient, and working capacity. Studies identified were assessed for risk of bias using the Cochrane Collaboration Tool for Assessing Risk of Bias. We used inverse variance analysis of fixed effects to compute for mean difference, carried out using Review Manager (RevMan) 5.3. RESULTS Pooled analysis from five identified trials showed that among patients with MS in sinus rhythm, ivabradine was better compared to beta-blockers in total exercise duration (mean difference: 32.73 s (95% CI: 12.19, 53.27; P = 0.002; I2 = 0%)), maximum HR achieved after exercise (mean difference: -3.87 beats per minute (95% CI: -5.88, -1.860; P = 0.0002; I2 = 23%)), and work capacity (mean difference: 0.56 METS (95% CI: 0.33, 0.80; P < 0.00001; I2 = 0%)); inferior to beta-blockers in resting HR achieved (mean difference: 1.83 s (95% CI: 0.39, 3.28; P = 0.01; I2 = 91%)); and comparable to beta-blockers in terms of mean gradient (mean difference: -0.52 mm Hg (95% CI: -1.20, 0.16; P = 0.13; I2 = 6%)). CONCLUSIONS Ivabradine is better or comparable to beta-blockers in terms of the outcomes measured, and may be considered as an alternative for patients with MS in sinus rhythm who are intolerant to beta-blockers.
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Affiliation(s)
- John Daniel A. Ramos
- Department of Medicine, Section of Cardiology, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Elleen L. Cunanan
- Department of Medicine, Section of Cardiology, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Lauro L. Abrahan
- Department of Medicine, Section of Cardiology, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Marc Denver A. Tiongson
- Department of Medicine, Section of Cardiology, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Felix Eduardo R. Punzalan
- Department of Medicine, Section of Cardiology, University of the Philippines, Philippine General Hospital, Manila, Philippines
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9
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Guha S, Harikrishnan S, Ray S, Sethi R, Ramakrishnan S, Banerjee S, Bahl VK, Goswami KC, Banerjee AK, Shanmugasundaram S, Kerkar PG, Seth S, Yadav R, Kapoor A, Mahajan AU, Mohanan PP, Mishra S, Deb PK, Narasimhan C, Pancholia AK, Sinha A, Pradhan A, Alagesan R, Roy A, Vora A, Saxena A, Dasbiswas A, Srinivas BC, Chattopadhyay BP, Singh BP, Balachandar J, Balakrishnan KR, Pinto B, Manjunath CN, Lanjewar CP, Jain D, Sarma D, Paul GJ, Zachariah GA, Chopra HK, Vijayalakshmi IB, Tharakan JA, Dalal JJ, Sawhney JPS, Saha J, Christopher J, Talwar KK, Chandra KS, Venugopal K, Ganguly K, Hiremath MS, Hot M, Das MK, Bardolui N, Deshpande NV, Yadava OP, Bhardwaj P, Vishwakarma P, Rajput RK, Gupta R, Somasundaram S, Routray SN, Iyengar SS, Sanjay G, Tewari S, G S, Kumar S, Mookerjee S, Nair T, Mishra T, Samal UC, Kaul U, Chopra VK, Narain VS, Raj V, Lokhandwala Y. CSI position statement on management of heart failure in India. Indian Heart J 2018; 70 Suppl 1:S1-S72. [PMID: 30122238 PMCID: PMC6097178 DOI: 10.1016/j.ihj.2018.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Santanu Guha
- Chairman, CSI Guidelines Committee; Medical College Kolkata, India
| | - S Harikrishnan
- Chief Coordinator, CSI HF Position Statement; Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India.
| | - Saumitra Ray
- Convenor, CSI Guidelines Committee; Vivekananda Institute of Medical Sciences, Kolkata
| | - Rishi Sethi
- Joint Coordinator, CSI HF Position Statement; KG Medical University, Lucknow
| | - S Ramakrishnan
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Suvro Banerjee
- Joint Convenor, CSI Guidelines Committee; Apollo Hospitals, Kolkata
| | - V K Bahl
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - K C Goswami
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Amal Kumar Banerjee
- Institute of Post Graduate Medical Education & Research, Kolkata, West Bengal, India
| | - S Shanmugasundaram
- Department of Cardiology, Tamil Nadu Medical University, Billroth Hospital, Chennai, Tamil Nadu, India
| | | | - Sandeep Seth
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Yadav
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Aditya Kapoor
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, Uttar Pradesh, India
| | - Ajaykumar U Mahajan
- Department of Cardiology, LokmanyaTilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - P P Mohanan
- Department of Cardiology, Westfort Hi Tech Hospital, Thrissur, Kerala, India
| | - Sundeep Mishra
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - P K Deb
- Daffodil Hospitals, Kolkata, West Bengal, India
| | - C Narasimhan
- Department of Cardiology & Chief of Electro Physiology Department, Care Hospitals, Hyderabad, Telangana, India
| | - A K Pancholia
- Clinical & Preventive Cardiology, Arihant Hospital & Research Centre, Indore, Madhya Pradesh, India
| | | | - Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - R Alagesan
- The Tamil Nadu Dr.M.G.R. Medical University, Tamil Nadu, India
| | - Ambuj Roy
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Amit Vora
- Arrhythmia Associates, Mumbai, Maharashtra, India
| | - Anita Saxena
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - B P Singh
- Department of Cardiology, IGIMS, Patna, Bihar, India
| | | | - K R Balakrishnan
- Cardiac Sciences, Fortis Malar Hospital, Adyar, Chennai, Tamil Nadu, India
| | - Brian Pinto
- Holy Family Hospitals, Mumbai, Maharashtra, India
| | - C N Manjunath
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | | | - Dharmendra Jain
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Dipak Sarma
- Cardiology & Critical Care, Jorhat Christian Medical Centre Hospital, Jorhat, Assam, India
| | - G Justin Paul
- Department of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
| | | | | | - I B Vijayalakshmi
- Bengaluru Medical College and Research Institute, Bengaluru, Karnataka, India
| | - J A Tharakan
- Department of Cardiology, P.K. Das Institute of Medical Sciences, Vaniamkulam, Palakkad, Kerala, India
| | - J J Dalal
- Kokilaben Hospital, Mumbai, Maharshtra, India
| | - J P S Sawhney
- Department of Cardiology, Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi, India
| | - Jayanta Saha
- Chairman, CSI Guidelines Committee; Medical College Kolkata, India
| | | | - K K Talwar
- Max Healthcare, Max Super Speciality Hospital, Saket, New Delhi, India
| | - K Sarat Chandra
- Indo-US Super Speciality Hospital & Virinchi Hospital, Hyderabad, Telangana, India
| | - K Venugopal
- Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
| | - Kajal Ganguly
- Department of Cardiology, N.R.S. Medical College, Kolkata, West Bengal, India
| | | | - Milind Hot
- Department of CTVS, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Mrinal Kanti Das
- B.M. Birla Heart Research Centre & CMRI, Kolkata, West Bengal, India
| | - Neil Bardolui
- Department of Cardiology, Excelcare Hospitals, Guwahati, Assam, India
| | - Niteen V Deshpande
- Cardiac Cath Lab, Spandan Heart Institute and Research Center, Nagpur, Maharashtra, India
| | - O P Yadava
- National Heart Institute, New Delhi, India
| | - Prashant Bhardwaj
- Department of Cardiology, Military Hospital (Cardio Thoracic Centre), Pune, Maharashtra, India
| | - Pravesh Vishwakarma
- Joint Coordinator, CSI HF Position Statement; KG Medical University, Lucknow
| | | | - Rakesh Gupta
- JROP Institute of Echocardiography, New Delhi, India
| | | | - S N Routray
- Department of Cardiology, SCB Medical College, Cuttack, Odisha, India
| | - S S Iyengar
- Manipal Hospitals, Bangalore, Karnataka, India
| | - G Sanjay
- Chief Coordinator, CSI HF Position Statement; Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
| | - Satyendra Tewari
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, Uttar Pradesh, India
| | | | - Soumitra Kumar
- Convenor, CSI Guidelines Committee; Vivekananda Institute of Medical Sciences, Kolkata
| | - Soura Mookerjee
- Chairman, CSI Guidelines Committee; Medical College Kolkata, India
| | - Tiny Nair
- Department of Cardiology, P.R.S. Hospital, Trivandrum, Kerala, India
| | - Trinath Mishra
- Department of Cardiology, M.K.C.G. Medical College, Behrampur, Odisha, India
| | | | - U Kaul
- Batra Heart Center & Batra Hospital and Medical Research Center, New Delhi, India
| | - V K Chopra
- Heart Failure Programme, Department of Cardiology, Medanta Medicity, Gurugram, Haryana, India
| | - V S Narain
- Joint Coordinator, CSI HF Position Statement; KG Medical University, Lucknow
| | - Vimal Raj
- Narayana Hrudayalaya Hospital, Bangalore, Karnataka, India
| | - Yash Lokhandwala
- Mumbai & Visiting Faculty, Sion Hospital, Mumbai, Maharashtra, India
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13
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Rajesh GN, Sajeer K, Sajeev CG, Bastian C, Vinayakumar D, Muneer K, Haridasan V, Mathew D, George B, Krishnan MN. A comparative study of ivabradine and atenolol in patients with moderate mitral stenosis in sinus rhythm. Indian Heart J 2016; 68:311-5. [PMID: 27316483 DOI: 10.1016/j.ihj.2015.09.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 09/20/2015] [Accepted: 09/28/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND 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) 5mg twice daily or atenolol (n=40) 50mg 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±99.05s vs. 349.12±103.53s; p=0.0001 in ivabradine group, 290.90±92.42s vs. 339.90±99.84s; 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.
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Affiliation(s)
- Gopalan Nair Rajesh
- Additional Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala 673008, India.
| | - Kalathingathodika Sajeer
- Senior Resident, Department of Cardiology, Government Medical College, Kozhikode, Kerala 673008, India
| | - Chakanalil Govindan Sajeev
- Professor, Additional Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala 673008, India
| | - Cicy Bastian
- Additional Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala 673008, India
| | - Desabandhu Vinayakumar
- Additional Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala 673008, India
| | - Kader Muneer
- Associate Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala 673008, India
| | - Vellani Haridasan
- Assistant Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala 673008, India
| | - Dolly Mathew
- Assistant Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala 673008, India
| | - Biju George
- Assistant Professor, Department of Community Medicine, Government Medical College, Kozhikode, Kerala, India
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14
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Kurtoglu E, Balta S, Karakus Y, Yasar E, Cuglan B, Kaplan O, Gozubuyuk G. Ivabradine improves heart rate variability in patients with nonischemic dilated cardiomyopathy. Arq Bras Cardiol 2014; 103:308-14. [PMID: 25119894 PMCID: PMC4206361 DOI: 10.5935/abc.20140109] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 03/24/2014] [Indexed: 12/20/2022] Open
Abstract
Background Ivabradine is a novel specific heart rate (HR)-lowering agent that improves
event-free survival in patients with heart failure (HF). Objectives We aimed to evaluate the effect of ivabradine on time domain indices of heart rate
variability (HRV) in patients with HF. Methods Forty-eight patients with compensated HF of nonischemic origin were included.
Ivabradine treatment was initiated according to the latest HF guidelines. For HRV
analysis, 24-h Holter recording was obtained from each patient before and after 8
weeks of treatment with ivabradine. Results The mean RR interval, standard deviation of all normal to normal RR intervals
(SDNN), the standard deviation of 5-min mean RR intervals (SDANN), the mean of the
standard deviation of all normal-to-normal RR intervals for all 5-min segments
(SDNN index), the percentage of successive normal RR intervals exceeding 50 ms
(pNN50), and the square root of the mean of the squares of the differences between
successive normal to normal RR intervals (RMSSD) were low at baseline before
treatment with ivabradine. After 8 weeks of treatment with ivabradine, the mean HR
(83.6 ± 8.0 and 64.6 ± 5.8, p < 0.0001), mean RR interval (713
± 74 and 943 ± 101 ms, p < 0.0001), SDNN (56.2 ± 15.7 and
87.9 ± 19.4 ms, p < 0.0001), SDANN (49.5 ± 14.7 and 76.4 ±
19.5 ms, p < 0.0001), SDNN index (24.7 ± 8.8 and 38.3 ± 13.1 ms,
p < 0.0001), pNN50 (2.4 ± 1.6 and 3.2 ± 2.2 %, p < 0.0001),
and RMSSD (13.5 ± 4.6 and 17.8 ± 5.4 ms, p < 0.0001)
substantially improved, which sustained during both when awake and while
asleep. Conclusion Our findings suggest that treatment with ivabradine improves HRV in nonischemic
patients with HF.
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Affiliation(s)
| | - Sevket Balta
- Department of Cardiology, Eskisehir Military Hospital, Eskisehir, Turkey
| | - Yasin Karakus
- Department of Cardiology, Malatya State Hospital, Malatya, Turkey
| | - Erdogan Yasar
- Department of Cardiology, Malatya State Hospital, Malatya, Turkey
| | - Bilal Cuglan
- Department of Cardiology, Malatya State Hospital, Malatya, Turkey
| | - Ozgur Kaplan
- Department of Cardiology, Malatya State Hospital, Malatya, Turkey
| | - Gokhan Gozubuyuk
- Department of Cardiology, Malatya State Hospital, Malatya, Turkey
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