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Five-year results of heart rate control with ivabradine or metoprolol succinate in patients after heart transplantation.
Clin Res Cardiol. 2020 Jun 22 [Online ahead of print]CR

Abstract

BACKGROUND

Cardiac graft denervation causes inadequate sinus tachycardia in patients after heart transplantation (HTX) which is associated with reduced survival. This study investigated the 5-year results of heart rate control with ivabradine or metoprolol succinate in patients after HTX.

METHODS

This registry study analyzed 104 patients receiving either ivabradine (n = 50) or metoprolol succinate (n = 54) within 5 years after HTX. Analysis included patient characteristics, medication, echocardiographic features, cardiac catheterization data, cardiac biomarkers, heart rates, and post-transplant survival including causes of death.

RESULTS

Demographics and post-transplant medication revealed no significant differences except for ivabradine and metoprolol succinate use. At 5-year follow-up, patients with ivabradine had a significantly lower heart rate (73.3 bpm) compared to baseline (88.6 bpm; P < 0.01) and to metoprolol succinate (80.4 bpm; P < 0.01), a reduced left ventricular mass (154.8 g) compared to baseline (179.5 g; P < 0.01) and to metoprolol succinate (177.3 g; P < 0.01), a lower left ventricular end-diastolic pressure (LVEDP; 12.0 mmHg) compared to baseline (15.5 mmHg; P < 0.01) and to metoprolol succinate (17.1 mmHg; P < 0.01), and a reduced NT-proBNP level (525.4 pg/ml) compared to baseline (3826.3 pg/ml; P < 0.01) and to metoprolol succinate (1038.9 pg/ml; P < 0.01). Five-year post-transplant survival was significantly better in patients with ivabradine (90.0%) versus metoprolol succinate (68.5%; P < 0.01).

CONCLUSION

Patients receiving ivabradine showed a superior heart rate reduction and a better left ventricular diastolic function along with an improved 5-year survival after HTX.

Authors+Show Affiliations

Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. rasmus.rivinius@med.uni-heidelberg.de. Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany. rasmus.rivinius@med.uni-heidelberg.de. German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany. rasmus.rivinius@med.uni-heidelberg.de.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. Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany. German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany.Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany. German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany.Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany. German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 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 Pneumology and Oncology, Asklepios Hospital, Bad Salzungen, Germany.Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany. German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany.Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32572551

Citation

Rivinius, Rasmus, et al. "Five-year Results of Heart Rate Control With Ivabradine or Metoprolol Succinate in Patients After Heart Transplantation." Clinical Research in Cardiology : Official Journal of the German Cardiac Society, 2020.
Rivinius R, Helmschrott M, Rahm AK, et al. Five-year results of heart rate control with ivabradine or metoprolol succinate in patients after heart transplantation. Clin Res Cardiol. 2020.
Rivinius, R., Helmschrott, M., Rahm, A. K., Darche, F. F., Thomas, D., Bruckner, T., Doesch, A. O., Katus, H. A., & Ehlermann, P. (2020). Five-year results of heart rate control with ivabradine or metoprolol succinate in patients after heart transplantation. Clinical Research in Cardiology : Official Journal of the German Cardiac Society. https://doi.org/10.1007/s00392-020-01692-z
Rivinius R, et al. Five-year Results of Heart Rate Control With Ivabradine or Metoprolol Succinate in Patients After Heart Transplantation. Clin Res Cardiol. 2020 Jun 22; PubMed PMID: 32572551.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Five-year results of heart rate control with ivabradine or metoprolol succinate in patients after heart transplantation. AU - Rivinius,Rasmus, AU - Helmschrott,Matthias, AU - Rahm,Ann-Kathrin, AU - Darche,Fabrice F, AU - Thomas,Dierk, AU - Bruckner,Tom, AU - Doesch,Andreas O, AU - Katus,Hugo A, AU - Ehlermann,Philipp, Y1 - 2020/06/22/ PY - 2020/02/09/received PY - 2020/06/17/accepted PY - 2020/6/24/entrez KW - Heart rate KW - Heart transplantation KW - Ivabradine KW - Metoprolol succinate KW - Mortality JF - Clinical research in cardiology : official journal of the German Cardiac Society JO - Clin Res Cardiol N2 - BACKGROUND: Cardiac graft denervation causes inadequate sinus tachycardia in patients after heart transplantation (HTX) which is associated with reduced survival. This study investigated the 5-year results of heart rate control with ivabradine or metoprolol succinate in patients after HTX. METHODS: This registry study analyzed 104 patients receiving either ivabradine (n = 50) or metoprolol succinate (n = 54) within 5 years after HTX. Analysis included patient characteristics, medication, echocardiographic features, cardiac catheterization data, cardiac biomarkers, heart rates, and post-transplant survival including causes of death. RESULTS: Demographics and post-transplant medication revealed no significant differences except for ivabradine and metoprolol succinate use. At 5-year follow-up, patients with ivabradine had a significantly lower heart rate (73.3 bpm) compared to baseline (88.6 bpm; P < 0.01) and to metoprolol succinate (80.4 bpm; P < 0.01), a reduced left ventricular mass (154.8 g) compared to baseline (179.5 g; P < 0.01) and to metoprolol succinate (177.3 g; P < 0.01), a lower left ventricular end-diastolic pressure (LVEDP; 12.0 mmHg) compared to baseline (15.5 mmHg; P < 0.01) and to metoprolol succinate (17.1 mmHg; P < 0.01), and a reduced NT-proBNP level (525.4 pg/ml) compared to baseline (3826.3 pg/ml; P < 0.01) and to metoprolol succinate (1038.9 pg/ml; P < 0.01). Five-year post-transplant survival was significantly better in patients with ivabradine (90.0%) versus metoprolol succinate (68.5%; P < 0.01). CONCLUSION: Patients receiving ivabradine showed a superior heart rate reduction and a better left ventricular diastolic function along with an improved 5-year survival after HTX. SN - 1861-0692 UR - https://www.unboundmedicine.com/medline/citation/32572551/Five-year_results_of_heart_rate_control_with_ivabradine_or_metoprolol_succinate_in_patients_after_heart_transplantation L2 - https://dx.doi.org/10.1007/s00392-020-01692-z DB - PRIME DP - Unbound Medicine ER -
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