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Better cardiovascular outcomes of combined therapy with ivabradine and bisoprolol versus bisoprolol alone in cardiac syndrome-x patients with bronchial asthma.

Session Poster Session 3

Speaker Naresh Sen

Event : ESC Preventive Cardiology (Formerly EuroPrevent) 2018

  • Topic : preventive cardiology
  • Sub-topic : Secondary Prevention
  • Session type : Poster Session

Authors : N Sen (BANGALORE,IN), SONAL Tanwar (Jaipur,IN), ASHOK Jain (Jaipur,IN), GEORGE Cherian (Bangalore,IN), S Jagdish (Jaipur,IN)

Authors:
N Sen1 , SONAL Tanwar2 , ASHOK Jain3 , GEORGE Cherian4 , S Jagdish5 , 1NARAYANA HRUDAYALAYA INSTITUTE OF MEDICAL SCIENCE - BANGALORE - India , 2HG SMS Hospital, Cardiology - Jaipur - India , 3Narayana Hrudayalaya, Cardiology - Jaipur - India , 4Narayana Hrudayalaya Institute of Medical Sciences, Cardiology - Bangalore - India , 5Rajasthan University of Health Sciences, Cardiology - Jaipur - India ,

Citation:
European Journal of Preventive Cardiology ( May 2018 ) 25 ( Supplement 1 ), 128

Background  Myocardial ischemia in patients with normal epicardial coronary arteries still pose a diagnostic challenge to the treating cardiologist which include a heterogeneous group of disorders include: cardiac syndrome X or microvascular angina. According to proved cardiac physiology high heart rate in patients with non obstructive coronary artery disease worsening microvascular angina. Bisoprolol and Ivabradine both we can use in microvascular angina or cardiac syndrome x . However, bisoprolol (Selective beta blocker used in asthamatic patients)  also has role in reduction of blood pressure which compromises cerebral perfusion pressure and may risk for stroke events .  Purpose  Our aim is to access cardiovascular outcomes like improvement of angina and dyspnea, increase exercise capacitiy , heart rate recovery and risk for stroke with comparison of Ivabradine with bisoprolol combination versus bisoprolol alone.  Method  3 years randomized observational study performed at three different cardiac centres. In our study, (n=78 )post menopausal women of non obstructive coronary aretery disease were enrolled. Age of patients - 43  to 69 yrs, Systolic Blood pressure -122 to 178 mmHg , Diastolic Blood pressure - 68 to 106 mmHg, Heart Rate - 94 to 133 beat/min. We have divided two groups : group A(n=40) treated with 2.5 to 5 mg bisoprolol daily with Ivabradine 5 mg twice daily and group B (n= 38) treated with bisoprolol 5 to 10 mg daily. We observed  class of angina , severity and duration of angina , cardiac function, stroke events rate and exercise test for functional capacity.  Result  Heart rate was reduced in both groups (more decreased in group A) but a greater reduction of blood pressure in group B with optimized dose of bisoprolol was observed . We found in group A significant reduction of duration and severity of angina as compared to group B (p<0.002) . According to 2D Echocardiography data revealed no significant difference regarding Left Ventricle systolic function however improved diastolic function and decreased strain rate in group A as compared to group B (P<0.04).There was  significant  reduction in stroke rate in group A(n=2) versus group B (n=4) (5% vs 10.5% , p<0.05). The distance walked on the 6-min walking test and the exercise time on MVO(2) test significantly improved A (P<0.03) and ST depression with recovery time improved on tread mill exercise test in group A as compared to group B(p<0.05).  Conclusion  Combined therapy with Ivabradine  and  bisoprolol  has better cardiovascular outcomes  with decreased unnecessary hospitalization due to microvascular angina in cardiac syndrome-x  patients.

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