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Control of cardiac chronotropic function in patients after heart transplantation: effects of ivabradine and metoprolol succinate on resting heart rate in the denervated heart.
Clin Res Cardiol. 2018 Feb; 107(2):138-147.CR

Abstract

BACKGROUND

Patients after heart transplantation (HTX) present with sinus tachycardia due to graft denervation. As elevated heart rates negatively affect survival, the aim of this study was to analyze the effects of ivabradine vs metoprolol succinate on heart rate, left ventricular (LV) mass and survival following HTX.

METHODS

This observational retrospective single-center study assessed 84 patients continuously receiving either ivabradine (n = 40) or metoprolol succinate (n = 44) within 2 years after HTX. Patients with dual therapy (ivabradine and metoprolol succinate), other beta blockers, amiodarone, or digitalis were excluded. Patient characteristics, post-transplant medication, heart rates, LV mass, and survival were investigated.

RESULTS

Analysis of patient characteristics, immunosuppressive drug regimen, and post-transplant medication showed no significant differences between groups except for ivabradine and metoprolol succinate. Baseline heart rates differed not significantly between patients treated with ivabradine [87.0 beats per minute (bpm)] and metoprolol succinate (86.2 bpm; P = 0.6395). At 2-year follow-up, patients with ivabradine (76.7 bpm) had a significantly lower heart rate compared to baseline (P < 0.0001) and to metoprolol succinate (82.0 bpm; P = 0.0283). LV mass in patients receiving ivabradine was lower at 2-year follow-up compared to baseline (P = 0.0067) and patients receiving metoprolol succinate (P = 0.0179). Patients with ivabradine had a superior 2-year survival after HTX (P = 0.0049).

CONCLUSION

Treatment with ivabradine in patients within 2 years after HTX significantly reduced post-transplant heart rate and LV mass and was associated with a superior survival in comparison with patients receiving metoprolol succinate.

Authors+Show Affiliations

Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany.Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. klinische.herztransplantation@med.uni-heidelberg.de.

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

eng

PubMed ID

29098378

Citation

Rivinius, Rasmus, et al. "Control of Cardiac Chronotropic Function in Patients After Heart Transplantation: Effects of Ivabradine and Metoprolol Succinate On Resting Heart Rate in the Denervated Heart." Clinical Research in Cardiology : Official Journal of the German Cardiac Society, vol. 107, no. 2, 2018, pp. 138-147.
Rivinius R, Helmschrott M, Ruhparwar A, et al. Control of cardiac chronotropic function in patients after heart transplantation: effects of ivabradine and metoprolol succinate on resting heart rate in the denervated heart. Clin Res Cardiol. 2018;107(2):138-147.
Rivinius, R., Helmschrott, M., Ruhparwar, A., Rahm, A. K., Darche, F. F., Thomas, D., Bruckner, T., Ehlermann, P., Katus, H. A., & Doesch, A. O. (2018). Control of cardiac chronotropic function in patients after heart transplantation: effects of ivabradine and metoprolol succinate on resting heart rate in the denervated heart. Clinical Research in Cardiology : Official Journal of the German Cardiac Society, 107(2), 138-147. https://doi.org/10.1007/s00392-017-1165-3
Rivinius R, et al. Control of Cardiac Chronotropic Function in Patients After Heart Transplantation: Effects of Ivabradine and Metoprolol Succinate On Resting Heart Rate in the Denervated Heart. Clin Res Cardiol. 2018;107(2):138-147. PubMed PMID: 29098378.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Control of cardiac chronotropic function in patients after heart transplantation: effects of ivabradine and metoprolol succinate on resting heart rate in the denervated heart. AU - Rivinius,Rasmus, AU - Helmschrott,Matthias, AU - Ruhparwar,Arjang, AU - Rahm,Ann-Kathrin, AU - Darche,Fabrice F, AU - Thomas,Dierk, AU - Bruckner,Tom, AU - Ehlermann,Philipp, AU - Katus,Hugo A, AU - Doesch,Andreas O, Y1 - 2017/11/02/ PY - 2017/06/24/received PY - 2017/09/19/accepted PY - 2017/11/4/pubmed PY - 2018/8/28/medline PY - 2017/11/4/entrez KW - Heart rate KW - Heart transplantation KW - Ivabradine KW - Metoprolol succinate KW - Mortality SP - 138 EP - 147 JF - Clinical research in cardiology : official journal of the German Cardiac Society JO - Clin Res Cardiol VL - 107 IS - 2 N2 - BACKGROUND: Patients after heart transplantation (HTX) present with sinus tachycardia due to graft denervation. As elevated heart rates negatively affect survival, the aim of this study was to analyze the effects of ivabradine vs metoprolol succinate on heart rate, left ventricular (LV) mass and survival following HTX. METHODS: This observational retrospective single-center study assessed 84 patients continuously receiving either ivabradine (n = 40) or metoprolol succinate (n = 44) within 2 years after HTX. Patients with dual therapy (ivabradine and metoprolol succinate), other beta blockers, amiodarone, or digitalis were excluded. Patient characteristics, post-transplant medication, heart rates, LV mass, and survival were investigated. RESULTS: Analysis of patient characteristics, immunosuppressive drug regimen, and post-transplant medication showed no significant differences between groups except for ivabradine and metoprolol succinate. Baseline heart rates differed not significantly between patients treated with ivabradine [87.0 beats per minute (bpm)] and metoprolol succinate (86.2 bpm; P = 0.6395). At 2-year follow-up, patients with ivabradine (76.7 bpm) had a significantly lower heart rate compared to baseline (P < 0.0001) and to metoprolol succinate (82.0 bpm; P = 0.0283). LV mass in patients receiving ivabradine was lower at 2-year follow-up compared to baseline (P = 0.0067) and patients receiving metoprolol succinate (P = 0.0179). Patients with ivabradine had a superior 2-year survival after HTX (P = 0.0049). CONCLUSION: Treatment with ivabradine in patients within 2 years after HTX significantly reduced post-transplant heart rate and LV mass and was associated with a superior survival in comparison with patients receiving metoprolol succinate. SN - 1861-0692 UR - https://www.unboundmedicine.com/medline/citation/29098378/Control_of_cardiac_chronotropic_function_in_patients_after_heart_transplantation:_effects_of_ivabradine_and_metoprolol_succinate_on_resting_heart_rate_in_the_denervated_heart_ L2 - https://dx.doi.org/10.1007/s00392-017-1165-3 DB - PRIME DP - Unbound Medicine ER -