Ye.N. Amosova, Yao Xu, A.B. Bezrodnyi, I.V. Prudkii, Ye.V. Andreyev, Yu.V. Rudenko, O.M. Gerula Comparative assessment of heart rate control with combination of ivabradine and metoprolol and metoprolol alone on heart rate variability and its systolic function in patients with Q-wave myocardial infarction and left ventricular ejection fraction < 45%.

The aim of the study was to compare the effect of heart rate control with combination of ivabradine with Β-blocker and Β-blocker alone on heart rate variability (HRV), left ventricular (LV) systolic function and plasma NT-proANP in patients with Q-wave myocardial infarction (MI), ejection fraction less than 45% and acute left ventricular failure. We examined 62 patients with first Q-wave MI with an ejection fraction < 45%, resting heart rate > 70 bpm and Killip class I–II on the first day of the disease, 71% of whom received reperfusion therapy. As part of the standard therapy, patients in group 1 (n=30) received metoprolol tartrate (average daily dose 116.5±5.8 mg). Patients in group 2 (n=32), apart from metoprolol tartrate (average daily dose 50.8±1.7 mg), received ivabradine (average daily dose 12.8±0.6 mg), starting from 4–6 days of the disease. Studies of heart rate variability, echocardiographic parameters, as well as concentration of NT-proANP in plasma enzyme immunoassay (ELISA) were performed in all patients at 25 days and in 6 months. After titration of Β-blocker and ivabradine in both groups heart rate was eQually decreased at 25 day and 6 months (all P>0.05). The control of heart rate with ivabradine added to the Β-blocker, compared with monotherapy with higher doses of Β-blocker, was associated with less severe reduction of SDNN and increase of LF/HF after 25 days and 6 months. Decrease of autonomic imbalance according to the temporal and spectral parameters of HRV in these patients after 6 months of therapy with Β-blocker and ivabradine was closely related with improvement of LV systolic function.

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