Ivabradine in Cardiovascular Disease

Feldman, Arthur M.

doi:10.1097/fjc.0000000000000237

Cited by 3 publications

(2 citation statements)

References 34 publications

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“…The results appear to favorably support the use of ivabradine as a viable option for patients with MS in sinus rhythm, especially to those who are intolerant to beta-blockers, or to whom beta-blockers are contraindicated [ 22 ]. Ergun et al [ 23 ], however, issued a cautionary letter to using ivabradine in MS in sinus rhythm patients, as ironically, ivabradine is associated with a 15% increase in incidence in atrial fibrillation, as shown in a meta-analysis [ 24 ].…”

Section: Discussionmentioning

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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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%

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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“…Two recent clinical studies found that the drug reduces heart rate in this atrial rhythm disturbance [43,44] . The rate control in this condition pobably depends on recent identified hyperpolarization-activated cyclic nucleotide-gated cation channel 4 (HCN4), the primary gene responsible for I f current expression throughout the myocardium (in the SA node) [45] . In addition, Mackiewicz et al previously have sperimentally demonstrated that Ivabradine also protects against ventricular arrhythmias in acute myocardial infarction in rats.…”

Section: Ivabradinementioning

confidence: 99%

Trimetazidine, Ranolazine, Ivabradine Antagonize Stable Coronary Artery Disease Otherwise From Conventional Anti-Ischemic Drugs

Cacciapuoti

2017

Journal of Cardiology and Therapy

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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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Ivabradine in Cardiovascular Disease

Cited by 3 publications

References 34 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

Trimetazidine, Ranolazine, Ivabradine Antagonize Stable Coronary Artery Disease Otherwise From Conventional Anti-Ischemic Drugs

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

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