Published January 30, 2024 | Version https://impactfactor.org/PDF/IJPCR/16/IJPCR,Vol16,Issue1,Article215.pdf
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Ivabradine versus Metoprolol in Patients with Mitral Stenosis in Sinus Rhythm- A Randomized Comparison on Efficacy and Impact on Quality of Life

Creators

  • 1. Assistant Professor, Department of Pharmacology, VIMSAR, Burla, Sambalpur, Odisha
  • 2. Professor, Department of Pharmacology, VIMSAR, Burla, Sambalpur, Odisha
  • 3. Associate Professor, Department of Pharmacology, VIMSAR, Burla, Sambalpur, Odisha
  • 4. Professor and Head, Department of Pharmacology, Pharmacology, VIMSAR, Burla, Sambalpur, Odisha
  • 5. Associate Professor, Department of Cardiology, VIMSAR, Burla, Sambalpur, Odisha

Description

Background: Beta-blockers are widely used in patients with mitral stenosis (MS) for heart rate (HR) control that alleviate exercise-related symptoms but with many limitations. Ivabradine, a novel selective bradycardic drug, may be promising outcomes in terms of safety and efficacy in rest and exercise.  Our study examined comparative efficacy of ivabradine and metoprolol on clinical, hemodynamic and exercise parameters with quality of life (QOL) in patients with MS in normal sinus rhythm. Material and Methods: Randomized single blind trial randomized 65 patients of different severity to BETA (n=33, metoprolol 50 mg BD) or IVA group (n=32, ivabradine 5 mg BD). After clinical evaluation, treadmill stress testing, Echocardiography, ECG at baseline, patients were re-evaluated after six months. EQ-5d-3L questionnaire evaluated QoL at 0,6 months. Results: Mean Resting HR in bpm significantly decreased over 6 months in both groups (88.59±12.77 to 71.75±6.04 in IVA; 88.30±12.37 to 72.61±9.9 in BETA) as well peak exercise HR (IVA 171.91±28.07 to 130.09±24.21 and BETA 167.55± 31.02 to 132.30±25.97) (p<.001) but was comparable intergroup (p>.05). on head to head, total exercise duration(TED) increased significantly in IVA(p=.002). In BETA minimum HR at Holter were significantly low (p<.001) with adverse bradycardic symptoms. No serious safety issues noted in IVA. QoL score (EQVAS) was significantly improved from baseline for both interventions (p<.001) as well as for IVA group (p<.001) whereas NYHA class improvement not significant. Conclusions: Metoprolol and ivabradine significantly improved clinical, hemodynamic, and exercise, QOL parameters from baseline. Ivabradine was superior in TED and Qol scores than metoprolol without significantly lowering minHR or BP. Ivabradine thus is an independent choice in rate control in MS with NSR.

 

 

Abstract (English)

Background: Beta-blockers are widely used in patients with mitral stenosis (MS) for heart rate (HR) control that alleviate exercise-related symptoms but with many limitations. Ivabradine, a novel selective bradycardic drug, may be promising outcomes in terms of safety and efficacy in rest and exercise.  Our study examined comparative efficacy of ivabradine and metoprolol on clinical, hemodynamic and exercise parameters with quality of life (QOL) in patients with MS in normal sinus rhythm. Material and Methods: Randomized single blind trial randomized 65 patients of different severity to BETA (n=33, metoprolol 50 mg BD) or IVA group (n=32, ivabradine 5 mg BD). After clinical evaluation, treadmill stress testing, Echocardiography, ECG at baseline, patients were re-evaluated after six months. EQ-5d-3L questionnaire evaluated QoL at 0,6 months. Results: Mean Resting HR in bpm significantly decreased over 6 months in both groups (88.59±12.77 to 71.75±6.04 in IVA; 88.30±12.37 to 72.61±9.9 in BETA) as well peak exercise HR (IVA 171.91±28.07 to 130.09±24.21 and BETA 167.55± 31.02 to 132.30±25.97) (p<.001) but was comparable intergroup (p>.05). on head to head, total exercise duration(TED) increased significantly in IVA(p=.002). In BETA minimum HR at Holter were significantly low (p<.001) with adverse bradycardic symptoms. No serious safety issues noted in IVA. QoL score (EQVAS) was significantly improved from baseline for both interventions (p<.001) as well as for IVA group (p<.001) whereas NYHA class improvement not significant. Conclusions: Metoprolol and ivabradine significantly improved clinical, hemodynamic, and exercise, QOL parameters from baseline. Ivabradine was superior in TED and Qol scores than metoprolol without significantly lowering minHR or BP. Ivabradine thus is an independent choice in rate control in MS with NSR.

 

 

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Dates

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2023-12-26

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References

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