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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

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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.

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Acknowledgements

This study was supported in part by research grants from the Faculty of Medicine, University of Heidelberg (Physician Scientist Scholarship to Ann-Kathrin Rahm). We thank Viola Deneke and Berthold Klein for their assistance and advice.

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Authors and Affiliations

  1. Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Rasmus Rivinius, Matthias Helmschrott, Ann-Kathrin Rahm, Fabrice F. Darche, Dierk Thomas, Philipp Ehlermann, Hugo A. Katus & Andreas O. Doesch

  2. Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany

    Arjang Ruhparwar

  3. Faculty of Medicine, University of Heidelberg, Heidelberg, Germany

    Ann-Kathrin Rahm

  4. Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany

    Tom Bruckner

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  1. Rasmus Rivinius
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  2. Matthias Helmschrott
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Correspondence to Andreas O. Doesch.

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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 107, 138–147 (2018). https://doi.org/10.1007/s00392-017-1165-3

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