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.
Clin Res Cardiol. 2018 Feb;107(2):138-147. doi: 10.1007/s00392-017-1165-3. Epub 2017 Nov 2.
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.
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.
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).
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.
心脏移植（HTX）后的患者由于移植物去神经支配而出现窦性心动过速。由于高心率会对生存率产生负面影响，因此本研究旨在分析伊伐布雷定与琥珀酸美托洛尔对 HTX 后心率、左心室（LV）质量和生存率的影响。
这项观察性回顾性单中心研究评估了 84 例 HTX 后 2 年内持续接受伊伐布雷定（n=40）或琥珀酸美托洛尔（n=44）治疗的患者。排除了接受双重治疗（伊伐布雷定和琥珀酸美托洛尔）、其他β受体阻滞剂、胺碘酮或地高辛的患者。研究了患者特征、移植后药物、心率、LV 质量和生存率。
分析患者特征、免疫抑制药物方案和移植后药物发现，除伊伐布雷定和琥珀酸美托洛尔外，各组之间无显著差异。伊伐布雷定组[87.0 次/分（bpm）]和琥珀酸美托洛尔组的基线心率无显著差异（86.2 bpm；P=0.6395）。在 2 年随访时，伊伐布雷定组（76.7 bpm）的心率明显低于基线（P<0.0001）和琥珀酸美托洛尔组（82.0 bpm；P=0.0283）。接受伊伐布雷定治疗的患者在 2 年随访时的 LV 质量低于基线（P=0.0067）和接受琥珀酸美托洛尔治疗的患者（P=0.0179）。伊伐布雷定组患者的 HTX 后 2 年生存率更高（P=0.0049）。
HTX 后 2 年内接受伊伐布雷定治疗的患者显著降低了移植后心率和 LV 质量，并与接受琥珀酸美托洛尔治疗的患者相比，生存率更高。
