scholarly journals Influence of carriage of genetic variants CYP2D6 * 4 / CYP2D6 * 3 on maximum heart rate when using bisoprolol in patients with acute coronary syndrome

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
VA Shumkov ◽  
KA Zagorodnikova ◽  
SA Boldueva ◽  
VB Petrova
Keyword(s):  
Heart Rate ◽  
Acute Coronary Syndrome ◽  
Metabolic Rate ◽  
High Efficiency ◽  
Current Therapy ◽  
Published Data ◽  
Cyp2d6 Genotype ◽  
Maximum Heart Rate ◽  
Cyp2d6 Activity ◽  
Coronary Syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Bisoprolol is one of the most effective and frequently prescribed beta-blockers. The widespread use of bisoprolol is due to its high efficiency in the treatment of patients with various cardiological pathologies: arterial hypertension, ischemic heart disease, chronic heart failure. Bisoprolol, like all members of the group of beta-adrenergic blockers, is effective in the treatment of patients with acute myocardial infarction, reducing the risk of complications such as rhythm disturbances and sudden cardiac death. In vitro studies indicate that bisoprolol is a substrate for two isoforms of cytochrome P450 - 3A4 and 2D6. Purpose The purpose of this work was to analyze the effect of CYP2D6 activity on the chronotropic effect of bisoprolol therapy in patients with acute coronary syndrome (ACS). Materials and methods The study included patients with ACS who was assigned bisoprolol according to clinical indications. All patients included in the study were Holter monitor on the 10th day of hospitalization - the minimum, mean, maximum heart rate during the day and the maximum heart rate were assessed at the time of exercise was evaluated against the background of the current therapy. All patients included in the study also underwent molecular genetic testing. The detection of polymorphic variants of СYP2D6 (*3/*4) gene was carried out by real-time PCR. Results A total of 93 patients, 58 males and 35 females were included in the study. The average age of patients is 63 years.  In the studied population, CYP2D6 * 3 was not detected. The CYP2D6 * 4 mutation occurred with a frequency of 15%, which is comparable to previously published data on the Russian population. The distribution of alleles corresponded to the Hardy-Weinberg law (Chi square, p> 0.05). In order to determine the effect of genetically determined CYP2D6 activity on the effectiveness of bisoprolol therapy in patients with ACS, we identified a group of patients - carriers of the allelic CYP2D6 * 4 variant in homozygous or heterozygous form (AA / AG) (group with a reduced metabolic rate), and a group with the CYP2D6 genotype GG (group with normal and increased metabolic rate). In the correlation analysis, carriage of CYP2D6 * 4 in heterozygous or homozygous form was associated with a lower maximum heart rate during exercise (r-0.21; p <0.05). Maximum heart rate during exercise in carriers of CYP2D6 * 4 was 107 [105; 119], in the comparison group - 114 [108; 120]. The difference was significant with p <0.05 (values are expressed as median [25%; 75%]). Conclusion In this study, for the first time, the role of the influence of allelic variants of the CYP2D6 gene on the achievement of maximum heart rate during exercise was revealed when using bisoprolol in patients with ACS. These data may have promising implications for maximizing the personalization of therapy for patients, including those with ACS.

Complex Heart Rate Control in Patients with Acute Coronary Syndrome

2017 ◽  
Vol 2 (6) ◽  
pp. 68-70
Author(s):  
S. Grechko ◽  
◽  
I. Trefanenko ◽  
O. Polishchuk ◽  
N. Turubarova-Leunova
Keyword(s):  
Heart Rate ◽  
Acute Coronary Syndrome ◽  
Rate Control ◽  
Heart Rate Control ◽  
Coronary Syndrome

Characteristics of heart rate variability in patients with acute coronary syndrome without ST segment elevation in comparison with clinical and biochemical parameters

2021 ◽  
Vol 29 (3) ◽  
pp. 369-378
Author(s):  
Aleksej A. Nizov ◽  
Aleksej I. Girivenko ◽  
Mihail M. Lapkin ◽  
Aleksej V. Borozdin ◽  
Yana A. Belenikina ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Acute Coronary Syndrome ◽  
Creatine Phosphokinase ◽  
Spectral Power ◽  
Low Frequency ◽  
Heart Rhythm ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

BACKGROUND: The search for rational methods of primary, secondary, and tertiary prevention of coronary heart disease. To date, there are several publications on heart rate variability in ischemic heart disease. AIM: To study the state of the regulatory systems in the organism of patients with acute coronary syndrome without ST segment elevation based on the heart rhythm, and their relationship with the clinical, biochemical and instrumental parameters of the disease. MATERIALS AND METHODS: The open comparative study included 76 patients (62 men, 14 women) of mean age, 61.0 0.9 years, who were admitted to the Emergency Cardiology Department diagnosed of acute coronary syndrome without ST segment elevation. On admission, cardiointervalometry was performed using Varicard 2.51 apparatus, and a number of clinical and biochemical parameters were evaluated RESULTS: Multiple correlations of parameters of heart rate variability and clinical, biochemical and instrumental parameters were observed. From this, a cluster analysis of cardiointervalometry was performed, thereby stratifying patients into five clusters. Two extreme variants of dysregulation of the heart rhythm correlated with instrumental and laboratory parameters. A marked increase in the activity of the subcortical nerve centers (maximal increase of the spectral power in the very low frequency range with the underlying reduction of SDNN) in cluster 1 was associated with reduction of the left ventricular ejection fraction: cluster 147.0 [40.0; 49.0], cluster 260.0 [58.0; 64.0], cluster 360.0 [52.5; 64.5] % (the data are presented in the form of median and interquartile range; Me [Q25; Q75], p 0,05). Cluster 5 showed significant reduction in SDNN (monotonous rhythm), combined with increased level of creatine phosphokinase (CPC): cluster 5446,0 [186.0; 782.0], cluster 4141.0 [98.0; 204.0] IU/l; Me [Q25; Q75], p 0.05) and MВ-fraction of creatine phosphokinase; cluster 532.0 [15.0; 45.0], 4 cluster 412.0 [9.0; 18.0] IU/l; Me [Q25; Q75], p 0.05). CONCLUSIONS: In patients with acute coronary syndrome without ST segment elevation, cluster analysis of parameters of heart rate variability identified different peculiarities of regulation of the heart rhythm. Pronounced strain of the regulatory systems of the body was found to be associated with signs of severe pathology: the predominance of VLF (spectral power of the curve enveloping a dynamic range of cardiointervals in the very low frequency range) in spectral analysis with an underlying reduced SDNN is characteristic of patients with a reduced ejection fraction, and a monotonous rhythm is characteristic of patients with an increased level of creatine phosphokinase and MB-fraction of creatine phosphokinase.

PATIENT AGE AND CYP2D6*4/CYP2D6*3 GENOTYPE ON MAXIMAL HEART RATE IN PATIENTS AFTER ACUTE CORONARY SYNDROME TREATED WITH BISOPROLOL

2021 ◽  
pp. 48-53
Author(s):  
В.А. Шумков ◽  
К.А. Загородникова ◽  
С. А. Болдуева ◽  
А.А. Мурзина ◽  
В.Б. Петрова
Keyword(s):  
Heart Rate ◽  
Acute Coronary Syndrome ◽  
Genetic Variants ◽  
Advanced Age ◽  
Maximal Heart Rate ◽  
Patient Age ◽  
Coronary Syndrome ◽  
Patient Âgé

Проанализировано влияние генетических вариантов CYP2D6*3 (2549delA) и CYP2D6*4 (1846G>A), а также других факторов на фармакодинамику бисопролола у пациентов с острым коронарным синдромом. В исследование были включены 97 пациентов, поступивших в клинику кардиологии с диагнозом острого коронарного синдрома, - 60 мужчин и 37 женщин, средний возраст - 63±10 лет. Выявлена взаимосвязь носительства аллельного варианта CYP2D6*4 (1846G>A) и максимальной ЧСС при нагрузке (R-0,21; р<0,05). При оценке влияния прочих факторов обнаружено, что основным предиктором максимальной ЧСС при нагрузке является возраст пациентов (β=-0,6; SE=0,07; p<0,001), при этом носительство CYP2D6*4 чаще встречается у лиц, переносящих острый коронарный синдром в более старшем возрасте (r=0,2; p<0,05). We have analyzed influence of genetic variants CYP2D6*3 (2549delA) and CYP2D6*4 (1846G>A), as well as other factors on effects of bisoprolol in patients with acute coronary syndrome. The study included 97 patients with acute coronary syndrome. Mean age was 63±10 years; 60 men and 37 women. We have found association between carriage of CYP2D6*4 (1846G>A) and maximal heart rate at exertion (R-0,21; р<0,05). When the correction for potential confounders was made, age was the only significant predictor of maximal heart rate (β=-0,6; SE=0,07; p<0,001). At the same time it was found that CYP2D6*4 was associated with more advanced age of the patients (r=0,2; p<0,05).

The relationship between phobic anxiety and 2-year readmission after Acute Coronary Syndrome: What is the role of heart rate variability?

2019 ◽  
Vol 247 ◽  
pp. 73-80 ◽  
Author(s):  
Adrienne O'Neil ◽  
C. Barr Taylor ◽  
David L. Hare ◽  
Emma Thomas ◽  
Samia R. Toukhsati ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Acute Coronary Syndrome ◽  
Coronary Syndrome ◽  
Phobic Anxiety ◽  
The Relationship

scholarly journals Heart Rate After Resuscitation From Out-of-Hospital Cardiac Arrest due to Acute Coronary Syndrome Is an Independent Predictor of Clinical Outcome

2020 ◽  
Vol 84 (4) ◽  
pp. 569-576 ◽  
Author(s):  
Shingo Matsumoto ◽  
Rine Nakanishi ◽  
Ippei Watanabe ◽  
Hiroto Aikawa ◽  
Ryota Noike ◽  
...  
Keyword(s):  
Heart Rate ◽  
Acute Coronary Syndrome ◽  
Cardiac Arrest ◽  
Clinical Outcome ◽  
Independent Predictor ◽  
Coronary Syndrome ◽  
Hospital Cardiac Arrest

scholarly journals COMPARISON STUDY OF IVABRADINE WITH METOPROLOL IN MANAGEMENT OF ACUTE CORONARY SYNDROME

2021 ◽  
Vol 5 (9) ◽  
Author(s):  
Rishman Tandi ◽  
Tanvi Kumar ◽  
Amritpal Singh Kahlon ◽  
Aaftab Sethi
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Acute Coronary Syndrome ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Beta Blocker ◽  
Beta Blockers ◽  
Coronary Syndrome ◽  
Group A ◽  
Group B

Introduction: Acute coronary syndrome remains as one of the most important causes for morbidity and mortality in developed countries. Therefore, evidence-based management strategy is required to offset the loss of health during an acute coronary syndrome. An effective approach includes both medical and surgical methods. This study was conducted to evaluate the medical method of management. Objective: To study blood pressure and heart rate variability after administration of Ivabradine or metoprolol in cases with acute coronary syndrome. Materials and methods: The study was a Prospective single center observational study conducted in patients attending Cardiology Intensive Care Unit in Nayyar Heart and Superspecialty Hospital, a tertiary care centre located in an urban area. All patients with Acute coronary syndrome admitted to the emergency or cardiac care unit were analysed with ECG as a preliminary diagnostic test and confirmed with troponin markers. They were either given Ivabradine or Metoprolol. Baseline evaluation and follow up was done and necessary data was collected and analysed.   Results: 100 patients were included in the study out of which 50 were given Metoprolol (Group A) and 50 were given Ivabradine (Group B). Themean age of studied cases was found to be 66.54 years in group A and 68.69 years in group B. It was observed that there was a fall in heart rate by 26.8 beats per minute with beta blocker and 24.4 beats per minute with Ivabradine. In case of blood pressure measurement, in patients with beta blocker administration, there was a fall of 25 mm Hg in systolic blood pressure and 17 mm Hg in diastolic blood pressure However, with Ivabradine there was only a fall of 8mm Hg in systolic Blood pressure and 6 mm Hg in diastolic blood pressure. Conclusion: Although Metoprolol is the drug of choice to decrease heart rate and blood pressure in acute coronary syndrome, Ivabradine is being increasingly used in cases where beta blockers are contraindicated as it has similar efficacy in lowering heart rate without compromising contractility of cardiac muscle, thereby maintaining LVEF and blood pressure. Keywords: Acute coronary syndrome, Beta Blockers, Metoprolol, Ivabradine.

A PROSPECTIVE CONSIDERATIONS AND COMPARATIVE EFFICACY BETWEEN IVABRADINE VS BETA BLOCKERS IN SOUTH INDIAN ACUTE CORONARY SYNDROME PATIENTS

2019 ◽  
pp. 193-195
Author(s):  
Hemanth Kumar Lekkala
Keyword(s):  
Heart Rate ◽  
Acute Coronary Syndrome ◽  
Beta Blockers ◽  
Statistical Significance ◽  
Reduced Ejection Fraction ◽  
Coronary Syndrome ◽  
Nyha Classification ◽  
South Indian ◽  
Group A ◽  
Group B

Objectives: the objective of this study was to assess the role of heart rate in acute coronary syndrome with reduced ejection fraction, to assess contraindications for beta blockers, to assess the tolerability between Ivabradine and Beta-Blockers, to assess efficacy between Ivabradine and Beta Blockers, to assess patient condition according to NYHA classification. Methods: A Prospective observational study was conducted for a duration of6 months Study population includes 100 patients in which Group A-50, Group B-50. We were selected the subjects according to inclusion and exclusion criteria. The patients were classified in one of four categories based on their symptoms in regards to normal breathing and varying degrees in shortness of breath by using (The New York Heart Association) NYHA Classification. Results: Majority of the patients were in age group between (55-64)(32%) years of age are highly affected with ACS. Prevalence of ACS is high in Rural (56%). Both drugs decreased the mean heart rate to 89.97±10.27 (Group-A) versus 86.76±13.14 (Group-B) beats per minute (P=0.24). The result obtained are clinically and statistically significant with statistical significance at P>0.05. Conclusion:  In the present study we considered and compared the efficacy between Ivabradine and Beta Blockers in south Indian acute coronary syndrome patients shows Ivabradine is as effective as betablockers in reduction of heart rate.    

scholarly journals Heart rate at admission is a predictor of in-hospital mortality in patients with acute coronary syndromes: Results from 58 European hospitals: The European Hospital Benchmarking by Outcomes in acute coronary syndrome Processes study

2016 ◽  
Vol 7 (2) ◽  
pp. 149-157 ◽  
Author(s):  
Magnus T Jensen ◽  
Marta Pereira ◽  
Carla Araujo ◽  
Anti Malmivaara ◽  
Jean Ferrieres ◽  
...  
Keyword(s):  
Heart Rate ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Beta Blockers ◽  
Heart Rates ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Coronary Syndromes ◽  
The Relationship

Aims: The purpose of this study was to investigate the relationship between heart rate at admission and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods: Consecutive ACS patients admitted in 2008–2010 across 58 hospitals in six participant countries of the European Hospital Benchmarking by Outcomes in ACS Processes (EURHOBOP) project (Finland, France, Germany, Greece, Portugal and Spain). Cardiogenic shock patients were excluded. Associations between heart rate at admission in categories of 10 beats per min (bpm) and in-hospital mortality were estimated by logistic regression in crude models and adjusting for age, sex, obesity, smoking, hypertension, diabetes, known heart failure, renal failure, previous stroke and ischaemic heart disease. In total 10,374 patients were included. Results: In both STEMI and NSTE-ACS patients, a U-shaped relationship between admission heart rate and in-hospital mortality was found. The lowest risk was observed for heart rates between 70–79 bpm in STEMI and 60–69 bpm in NSTE-ACS; risk of mortality progressively increased with lower or higher heart rates. In multivariable models, the relationship persisted but was significant only for heart rates >80 bpm. A similar relationship was present in both patients with or without diabetes, above or below age 75 years, and irrespective of the presence of atrial fibrillation or use of beta-blockers. Conclusion: Heart rate at admission is significantly associated with in-hospital mortality in patients with both STEMI and NSTE-ACS. ACS patients with admission heart rate above 80 bpm are at highest risk of in-hospital mortality.

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