title: Metoprolol vs ivabradine in patients with mitral stenosis in sinus rhythm.
abstract: BACKGROUND
  Severe mitral stenosis is usually symptomatic and is treated by BMV or surgery, whereas mild to moderate mitral stenosis is usually asymptomatic or mildly symptomatic and managed medically. Patients in the later group may become symptomatic during episodes of exercise and increased heart rate. 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 investigate the comparative efficacy of ivabradine versus metoprolol in patients with mitral stenosis in sinus rhythm.
  
  
  METHODS
  We studied 97 patients of mitral stenosis in sinus rhythm presented with exertional symptoms. The effectiveness of Metoprolol was compared with ivabradine in alleviating these exertional symptoms in a randomized, open label non crossover study. We also assessed various stress ECG parameters, 24 hour Holter parameters and 2D Echo parameters to objectively compare the effects of ivabradine and metoprolol in these patients.
  
  
  RESULTS
  Ivabradine and metoprolol both were effective in controlling exertional symptoms. Significant improvement in objective parameters like TMT (work capacity, baseline heart rate and maximal heart rate) and 2D echocardiography (right ventricular systolic pressure) are seen with both drugs. Ivabradine controls the exertional symptoms significantly more than metoprolol. On head to head comparison there was a significant benefit of working capacity and heart rate at maximal exercise in favour of ivabradine.
  
  
  CONCLUSIONS
  Ivabradine should be strongly considered in medical management of mitral stenosis patients where beta blockers are contraindicated such as reactive airway disease. The cost of ivabradine is higher than metoprolol which might possess constraints as most of the rheumatic heat disease patients belong to low socio economic status.
authors.affiliation: Department of Cardiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India. Electronic address: vikky25@yahoo.com.
authors.forename: Vikas
authors.initials: V
authors.lastname: Agrawal
authors.affiliation: Department of Cardiology, Medanta the Mediciti, Gurgaon, Haryana, India.
authors.forename: Niraj
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Department of Cardiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
authors.forename: Balalji
authors.initials: B
authors.lastname: Lohiya
authors.affiliation: Department of Cardiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
authors.forename: Bhupendra K
authors.initials: BK
authors.lastname: Sihag
authors.affiliation: Department of Cardiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
authors.forename: Rajpal
authors.initials: R
authors.lastname: Prajapati
authors.affiliation: Division of Biostatistics, Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
authors.forename: T B
authors.initials: TB
authors.lastname: Singh
authors.affiliation: Department of Cardiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
authors.forename: Geetha
authors.initials: G
authors.lastname: Subramanian
mesh_terms: D000293:Adolescent; D000328:Adult; D001552:Benzazepines / Q000008:administration & dosage / Q000009:adverse effects; D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000009:adverse effects; D016903:Drug Monitoring / Q000379:methods; D004452:Echocardiography / Q000379:methods; D015716:Electrocardiography, Ambulatory / Q000379:methods; D005080:Exercise Test / Q000379:methods; D017079:Exercise Tolerance / Q000187:drug effects*; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D000077550:Ivabradine; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage / Q000009:adverse effects; D008946:Mitral Valve Stenosis / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D063189:Symptom Assessment / Q000379:methods; D016896:Treatment Outcome
chemical_list: D001552:Benzazepines; D002317:Cardiovascular Agents; D000077550:Ivabradine; D008790:Metoprolol
keywords: Exercise; Mitral; Stenosis