Beta-blockers for mitral stenosis

Sulit, Dennis V; Punzalan, Felix Eduardo R.

doi:10.1002/14651858.cd003337

Cited by 2 publications

(2 citation statements)

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“…HR control improves diastolic filling and prevents the rise of PCWP [ 18 ]. Several studies have demonstrated the value of beta-blockers in the hemodynamics and symptom improvement of MS [ 7 - 10 ]. In our study, we have shown that ivabradine was able to achieve a significantly lower maximal HR after exercise, compared to guideline-based HR controllers.…”

Section: Discussionmentioning

confidence: 99%

“…Beta-blockers have been shown in a number of trials to be effective as medical therapy in MS, though there are also conflicting data [ 7 - 10 ]. Another issue that besets beta-blockers in MS is the potential for adverse reactions, including fatigue, bronchoconstriction, AV blocks, depression, and intolerance [ 10 ]. In the ACC/AHA guidelines, beta-blockers, along with calcium antagonists, are choices for rate control in MS [ 6 ].…”

Section: Introductionmentioning

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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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: 99%

Section: Introductionmentioning

confidence: 99%

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

Abrahan,

Ramos,

Cunanan

et al. 2017

PJC

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Background: Symptoms of mitral stenosis (MS) are worsened during tachycardia and exercise. Beta-blockers (BB) are used in controlling heart rate (HR) in MS to relieve symptoms, but can cause significant side effects. Ivabradine has a selective action on the sinus node and is devoid of the usual side effects of BB. Only small studies have investigated the role of ivabradine in MS in sinus rhythm. Objectives: To compare the efficacy of ivabradine with BB in terms of exercise duration, maximum HR achieved, resting HR, mean gradient and working capacity among patients with MS in sinus rhythm Methods: We conducted a systematic search of studies in all languages using MEDLINE, Google Scholar, ScienceDirect, Scopus, Clinical Key, Cochrane and clinicaltrials.gov databases and review of reference lists of studies. We included randomized controlled trials that compared ivabradine and BB in adults with MS in sinus rhythm and reported data on exercise duration, maximum HR achieved, resting HR, mean gradient or working capacity. Identified studies 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 differences, carried out using Review Manager 5.3. Results: Pooled analysis from five identified trials showed that among patients with MS in sinus rhythm, ivabradine was better than BB in increasing total exercise duration (mean difference of 32.73 s [95% CI 12.19, 53.27; p=0.002; I2=0%]), reducing maximum HR achieved after exercise (mean difference -3.87 beats per minutes [95% CI -5.88, -1.860; p=0.0002; I2=23%]) and improving work capacity (mean difference of 0.56 metabolic equivalents [95% CI 0.33, 0.80; p<0.00001; I2=0%]). Ivabradine was inferior to BB in resting HR achieved (mean difference of 1.83 s [95% CI 0.39, 3.28; p=0.01; I2=91%]); and similar to BB in terms of mean blood pressure gradient (mean difference of -0.52 mmHg [95% CI -1.20, 0.16; p=0.13; I2=6%]). Conclusion: Ivabradine was better or at least similar to BB in most outcomes measured and may be considered as an alternative treatment for patients with MS in sinus rhythm who are intolerant to BB. Keywords: ivabradine, mitral stenosis.

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Beta-blockers for mitral stenosis

Cited by 2 publications

References 3 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

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

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