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


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).


CONCLUSIONS
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.
Additional Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala 673008, India. Electronic address: drrajeshgnair@gmail.com.
Gopalan Nair
GN
Rajesh
Senior Resident, Department of Cardiology, Government Medical College, Kozhikode, Kerala 673008, India.
Kalathingathodika
K
Sajeer
Professor, Additional Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala 673008, India.
Chakanalil Govindan
CG
Sajeev
Additional Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala 673008, India.
Cicy
C
Bastian
Additional Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala 673008, India.
Desabandhu
D
Vinayakumar
Associate Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala 673008, India.
Kader
K
Muneer
Assistant Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala 673008, India.
Vellani
V
Haridasan
Assistant Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala 673008, India.
Dolly
D
Mathew
Assistant Professor, Department of Community Medicine, Government Medical College, Kozhikode, Kerala, India.
Biju
B
George
Professor & Head, Department of Cardiology, Government Medical College, Kozhikode, Kerala 673008, India.
Mangalath Narayanan
MN
Krishnan
D000293:Adolescent; D058671:Adrenergic beta-1 Receptor Antagonists / Q000008:administration & dosage; D000328:Adult; D001262:Atenolol / Q000008:administration & dosage*; D001552:Benzazepines / Q000008:administration & dosage*; D054815:Cyclic Nucleotide-Gated Cation Channels; D015150:Echocardiography, Doppler; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D000077550:Ivabradine; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects*; D055815:Young Adult
D058671:Adrenergic beta-1 Receptor Antagonists; D001552:Benzazepines; D054815:Cyclic Nucleotide-Gated Cation Channels; D000077550:Ivabradine; D001262:Atenolol
Exercise; Mitral stenosis; Rate control; Tachycardia