Efficacy and Safety of Oral Ivabradine Versus Beta-blocker in Achieving Heart Rate Reduction Pre-Computed Tomography Coronary Angiogram (CTCA)

Abstract

Background: Pulmonary vein stenosis or thrombosis (PVST) following lung transplantation is a rare but serious complication that may lead to graft failure. Diagnosis is challenging, as its radiographical features mimic infection or other causes of pulmonary oedema. Transoesophageal echocardiography is often requested to evaluate anastamoses to exclude PVST, though reference ranges for normal Doppler flow in this setting are not widely known, and pulmonary vein velocities are often elevated in the immediate post-transplant period. Aims: To determine pulmonary vein Doppler flow ranges in patients not suspected to have PVST in the post transplant period. Methods: All lung transplants performed in the last six years were identified from a database. The pulmonary vein Doppler velocities were recorded from the left and the right pulmonary vein 'buttons'. Clinical details were reviewed to determine if a clinical suspicion of PVS was present. Velocities recorded on the first transthoracic echocardiogram (TTE) or transoesophageal echocardiogram (TOE) post transplant were recorded. Results: There were a total of 108 patients (five single lung transplants, 103 double), with baseline characteristics age 44 ± 13years, 50/108 female. Velocities were able to be measured in 43 patients (17 TOE, 26TTE), a median of 11 days post transplant. Two patients were diagnosed with PVS (systolic/diastolic velocities 120/180 cm/s and 120/220 cm/s) and these values were excluded from calculations. Right pulmonary veins Left pulmonary veins Systolic 69 ± 34 cm/s (range 20-200) 79 ± 37 cm/s (20-161) Diastolic 85 ± 34 cm/s (37-190) 95 ± 37 ± cm/s (40-177)

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

“…Although β‐blockers are generally used to achieve short‐term HR reduction during the scan, 16 studies have also investigated ivabradine for this purpose (Table 4). 68–83 One study did not show a benefit of adding single‐dose ivabradine to bisoprolol for additional HR lowering, whereas three studies demonstrated similar HR reduction compared to β‐blockers 70,74,81,82 . One of these studies reported more than twice as many patients treated with ivabradine required additional β‐blockade compared to metoprolol‐treated patients 82 .…”

Efficacy of Ivabradine versus β-Blockers for Heart Rate Reduction during Computed Tomography Coronary Angiography: A Meta-Analysis of Randomized Controlled Trials

“…Ivabradine is undoubtedly a potentially attractive alternative for inappropriate sinus tachycardia, stable angina, heart failure, and other cardiovascular diseases, and it has good prospects for clinical application. A number of studies [1,2,3,4,5,6,7,8,9,10] have shown that ivabradine plays an important role in HR reduction in CTCA, particularly in terms of quantification of the efficacy of pretreatment with ivabradine before CTCA. We therefore examined whether there was a significant difference via meta-analysis.…”