© 2008 European Society of Cardiology
Favourable effects of heart rate reduction with intravenous administration of ivabradine in patients with advanced heart failure
a Department of Cardiology, Fondazione IRCCS Policlinico San Matteo Pavia, Italy
b Section of Cardiology, Department of Lung, Blood and Heart, University of Pavia Pavia, Italy
c Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Milan, Italy
* Corresponding author. Tel.: +39 0382 503715; fax: +39 0382 503161. E-mail address: g.deferrari{at}smatteo.pv.it
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Abstract |
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Background: Heart rate (HR) reduction may be useful in treatment of patients with heart failure (HF). There are no data on the haemodynamic effects of ivabradine (a selective If current inhibitor) in advanced HF patients.
Aims: To assess the haemodynamic effects of ivabradine in patients with advanced HF and markedly depressed left ventricular (LV) function.
Methods and results: Ten NYHA class III patients (50±12 years, LV ejection fraction 21±7%) underwent 24-h haemodynamic monitoring. Ivabradine 0.1 mg/kg was infused over 90', followed by 0.05–0.075 mg/kg in the subsequent 90'. Baseline HR was 93±8 bpm, cardiac index (CI) 2.2±0.6 l/min*m2; LV stroke volume 44±11 ml and systolic work 39±13 g.
Ivabradine significantly reduced HR, by a maximum of 27% (to 68±9 bpm) at 4h, without decreasing CI. Ivabradine increased stroke volume and LV systolic work by a maximum of 51% (to 66±17 ml) and 53% (to 58±20 g) at 4h. No serious adverse events occurred.
Conclusion: In patients with advanced HF and markedly depressed LV function, the acute administration of ivabradine is well tolerated, effectively reduces HR, markedly increases stroke volume and preserves cardiac output. Ivabradine appears a promising approach for the treatment of patients with moderate and advanced heart failure.
Key Words: Haemodynamics • Heart failure • Heart rate • Sinoatrial node
Received October 2, 2007; Revised March 10, 2008; Accepted April 14, 2008
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