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

Rajesh, Gopalan Nair; Sajeer, Kalathingathodika; Sajeev, C.G.; Bastian, Cicy; Vinayakumar, Desabandhu; Muneer, Kader; Vellani, Haridasan; Mathew, Dolly; George, Biju; Krishnan, M.N.

doi:10.1016/j.ihj.2015.09.028

Cited by 12 publications

(7 citation statements)

References 20 publications

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“…This is in contrast to the earlier meta-analysis by Adviento et al [ 20 ], where ivabradine was not significantly different to beta-blocker with regards to these clinical parameters. Individually, the included studies [ 17 - 19 ] showed that ivabradine and beta-blockers were able to similarly improve these outcomes, but in our study, it appears that ivabradine is in fact better. Dhanger [ 21 ] was able to show a statistically significant improvement in exercise duration from baseline among symptomatic MS patients in sinus rhythm, when treated with ivabradine for 3 months.…”

Section: Discussionmentioning

confidence: 47%

“…Five studies, comprising a total of 362 patients, were included in this meta-analysis. Table 1 [ 16 - 19 , 21 ] gives the summary of the study characteristics. All of the studies are small, with the largest study having 97 patients.…”

Section: Resultsmentioning

confidence: 99%

“…Similarly, Saggu showed that ivabradine was comparable to metoprolol in reducing symptoms and improving hemodynamics in these patients [ 17 ]. Parakh showed that ivabradine is more effective than atenolol in effort-related symptoms [ 18 ], but this was not the same for the study by Rajesh [ 19 ].…”

Section: Introductionmentioning

confidence: 93%

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Ivabradine Versus Beta-Blockers in Mitral Stenosis in Sinus Rhythm: An Updated Meta-Analysis of Randomized Controlled Trials

et al. 2018

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BackgroundSymptoms 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.MethodsWe 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.ResultsPooled 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%)).ConclusionsIvabradine 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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Section: Discussionmentioning

confidence: 47%

Section: Resultsmentioning

confidence: 99%

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Ivabradine Versus Beta-Blockers in Mitral Stenosis in Sinus Rhythm: An Updated Meta-Analysis of Randomized Controlled Trials

et al. 2018

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“…Seven studies have evaluated the effects of HR reduction with ivabradine in patients with mild to moderate MS and normal sinus rhythm (Table 3). 58–64 In all studies, ivabradine showed a significant reduction in HR from baseline. Two studies showed significant benefits with ivabradine versus β‐blockers on exercise time and working capacity, respectively 58,62 .…”

Section: Resultsmentioning

confidence: 88%

Beyond Heart Failure and Ischemic Heart Disease: A Scoping Review of Novel Uses of Ivabradine in Adults

2020

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Ivabradine lowers heart rate by inhibiting the hyperpolarization-activated current in pacemaker cells, and its use for the treatment of heart failure (HF) and ischemic heart disease (IHD) is well described. Ivabradine may be an attractive treatment option for other conditions for which a reduction in heart rate is desirable but less is known about its role in these settings. The primary objective was to perform a scoping review summarizing the literature evaluating novel uses for ivabradine other than HF and IHD in adults. PubMed and EMBASE were searched for articles for all dates through September 2019. Search strategies combined terms generic, commercial/trade, and international names for ivabradine. Manual search of references was also performed to identify additional articles. Studies were included if they were published in English, evaluated the efficacy of ivabradine for indications other than HF or IHD in patients aged 18 years or older, and the primary outcome included clinically relevant end points. Articles were screened first by title and abstract followed by full-text screening of the remaining articles. After removal of duplicates, 1807 records were screened for inclusion and 84 studies were included in this scoping review. Novel uses of ivabradine were reported for various tachyarrhythmias, valvular heart disease, premedication for coronary computed tomography angiography, perioperative risk reduction, sepsis with and without multi-organ dysfunction syndrome, cor pulmonale, reactive airway disease, and erectile dysfunction. This scoping review identified several potential novel uses for ivabradine in adults. This review may help to identify existing gaps where further research is needed to elucidate the role of ivabradine for indications beyond HF and IHD. KEY WORDS ivabradine, tachycardia, asthma, CT angiography, perioperative risk reduction, pulmonary hypertension, multi-organ dysfunction syndrome, valvular heart disease.

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“…Beta blockers are the mainstay of therapy [27], while rate-limiting calcium antagonists or digoxin provide alternatives in atrial fibrillation. For patients in sinus rhythm, ivabradine is an emerging effective alternative [28]. If medical therapy fails, then exercise stress echocardiography is useful to assess the consequences of increase demand on transmittal gradients.…”

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confidence: 99%

Mitral stenosis in 2019: changing approaches for changing times

Lloyd

Badiani

Costa

et al. 2019

Expert Review of Cardiovascular Therapy

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

Abstract: 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.

Cited by 12 publications

References 20 publications

Ivabradine Versus Beta-Blockers in Mitral Stenosis in Sinus Rhythm: An Updated Meta-Analysis of Randomized Controlled Trials

Ivabradine Versus Beta-Blockers in Mitral Stenosis in Sinus Rhythm: An Updated Meta-Analysis of Randomized Controlled Trials

Beyond Heart Failure and Ischemic Heart Disease: A Scoping Review of Novel Uses of Ivabradine in Adults

Mitral stenosis in 2019: changing approaches for changing times

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