Cardiology Xagena

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Metoprolol vs Ivabradine – Ivabradine in medical management of mitral stenosis patients where beta-blockers are contraindicated

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 the study was to investigate the comparative efficacy of Ivabradine ( Corlentor, Procoralan ) versus Metoprolol ( Lopresor ) in patients with mitral stenosis in sinus rhythm.

Researchers 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.
Researchers 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.

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.

In conclusion, Ivabradine should be strongly considered in medical management of mitral stenosis patients where beta-blockers are contraindicated such as reactive airway disease. ( Xagena )

Agrawal V et al, Int J Cardiol 2016;221:562-566