Ye.N. Amosova, Yao Xu, A.B. Bezrodnyi, Ye.V. Andreyev, I.V. Prudkii, N.V. Shishkina, O.M. Gerula, Yu.А. Sychenko, I.I. Gorda, I.Yu. Katsitadze Comparative evaluation of influence of metoprolol combined with ivabradine and metoprolol alone upon left ventricular systolic function, exercise tolerance and its hemodynamic support in patients with Q wave myocardial infarction and ejection fraction < 45%, at 6-month follow-up.

The aim of the study was to compare the effect of heart rate control with combination of Β-blocker and ivabradine and Β-blocker alone upon systolic function, exercise tolerance and hemodynamic support of physical activity in patients with Q-wave myocardial infarction (MI), left ventricular (LV) ejection fraction (EF) < 45% and sinus rhythm at the early (1 month) and later (6 months) periods. We examined 28 patients with first Q-wave MI with an EF < 45%, resting heart rate (HR) > 70 bpm and „S. Killip class I.II on the first day of the disease, all of whom received reperfusion therapy. As part of the standard therapy, patients in group 1 (n=12) received metoprolol tartrate (average daily dose 105.4±5.2 mg). Patients in group 2 (n=16), apart from metoprolol tartrate (average daily dose 55.3±1.7 mg), received ivabradine (average daily dose 11.3±1.5 mg), starting from 4.6 days of disease. Studies of exercise tolerance and echocardiographic parameters were performed in all patients at 28 days and in 6 months. After titration of Β-blocker and ivabradine in both groups HR was equally decreased at 28 day and 6 months (all P>0.05). The control of HR with ivabradine added to the Β-blocker, compared with monotherapy with higher doses of Β-blocker, contributes to improving LV systolic function and exercise tolerance. At the same relative increase of exercise tolerance at 6 months combination therapy was associated with larger relative increase in heart rate and double product at peak exercise.

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