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Guglin M. Ivabradine in Cardiogenic Shock. J Card Fail 2024:S1071-9164(24)00203-3. [PMID: 38880248 DOI: 10.1016/j.cardfail.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 05/12/2024] [Accepted: 05/21/2024] [Indexed: 06/18/2024]
Affiliation(s)
- Maya Guglin
- Indiana University School of Medicine, Indianapolis, IN.
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2
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Pasetto M, Calabrò LA, Annoni F, Scolletta S, Labbé V, Donadello K, Taccone FS. Ivabradine in Septic Shock: A Narrative Review. J Clin Med 2024; 13:2338. [PMID: 38673611 PMCID: PMC11051007 DOI: 10.3390/jcm13082338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
In patients with septic shock, compensatory tachycardia initially serves to maintain adequate cardiac output and tissue oxygenation but may persist despite appropriate fluid and vasopressor resuscitation. This sustained elevation in heart rate and altered heart rate variability, indicative of autonomic dysfunction, is a well-established independent predictor of adverse outcomes in critical illness. Elevated heart rate exacerbates myocardial oxygen demand, reduces ventricular filling time, compromises coronary perfusion during diastole, and impairs the isovolumetric relaxation phase of the cardiac cycle, contributing to ventricular-arterial decoupling. This also leads to increased ventricular and atrial filling pressures, with a heightened risk of arrhythmias. Ivabradine, a highly selective inhibitor of the sinoatrial node's pacemaker current (If or "funny" current), mitigates heart rate by modulating diastolic depolarization slope without affecting contractility. By exerting a selective chronotropic effect devoid of negative inotropic properties, ivabradine shows potential for improving hemodynamics in septic shock patients with cardiac dysfunction. This review evaluates the plausible mechanisms and existing evidence regarding the utility of ivabradine in managing patients with septic shock.
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Affiliation(s)
- Marco Pasetto
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
- Department of Surgery, Dentistry, Gynecology and Paediatrics, University of Verona, 37129 Verona, Italy
| | - Lorenzo Antonino Calabrò
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Filippo Annoni
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Sabino Scolletta
- Anesthesia and Intensive Care Unit, Department of Medicine, Surgery and Neuroscience, University Hospital of Siena, 53100 Siena, Italy
| | - Vincent Labbé
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Katia Donadello
- Department of Surgery, Dentistry, Gynecology and Paediatrics, University of Verona, 37129 Verona, Italy
- Anesthesia and Intensive Care Unit B, University Hospital Integrated Trust of Verona, 37134 Verona, Italy
| | - Fabio Silvio Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
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Alcaraz-Guzmán A, Amaro-Palomo EJ, Ruiz-Beltrán AM, Díaz-Herrera BÁ, Neri-Bale RR, Hernández-Bravo L, Candia-Ramírez MA, Gopar-Nieto R, González-Pacheco H, Sierra-Lara Martinez JD, Arias-Mendoza A, Araiza-Garaygordobil D. A randomized controlled trial of ivabradine in patients with acute myocardial infarction related cardiogenic shock. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2024; 5:e342. [PMID: 39015193 PMCID: PMC11247970 DOI: 10.47487/apcyccv.v5i2.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/15/2024] [Indexed: 07/18/2024]
Abstract
Objective . Acute myocardial infarction-related cardiogenic shock (AMI-CS) is often accompanied by tachycardia, which, in turn, increases myocardial oxygen consumption and hinders the use of ventricular assist devices, such as intra-aortic balloon pump. Evidence suggests that ivabradine may reduce heart rate (HR) without affecting other hemodynamic parameters. The aim of the present study was to determine the effect of ivabradine on reducing HR and changes in other hemodynamic parameters such as cardiac index (CI), in patients with AMI-CS and tachycardia. Materials and methods . A single-center, open label, randomized clinical trial included patients diagnosed with AMI-CS and tachycardia with >100 beats per minute (BPM). Heart rate, cardiac index, and other hemodynamic parameters measured by pulmonary flotation catheter were compared at 0, 6, 12, 24, and 48 hours after randomization. Results . A total of 12 patients were randomized; 6 received standard therapy, and 6 received ivabradine in addition to standard therapy. Baseline clinical characteristics were similar at randomization. A statistically significant lower heart rate was found at 12 hours (p=0.003) and 48 hours (p=0.029) after randomization, with differences of -23.3 (-8.2 to -38.4) BPM and -12.6 (-0.5 to -25.9) BPM, respectively. No differences in cardiac index, or any other evaluated hemodynamic parameters, length of hospital stay, nor mortality rate were noted between both groups. Conclusions . The use of ivabradine in patients with AMI-CS was associated with a significant reduction in heart rate at 12 and 48 h, without affecting other hemodynamic parameters.
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Affiliation(s)
- Alejandro Alcaraz-Guzmán
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
| | - Eder Jonathan Amaro-Palomo
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
| | - Arturo Maximiliano Ruiz-Beltrán
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
| | - Braiana Ángeles Díaz-Herrera
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
| | - Raúl Rodrigo Neri-Bale
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
| | - Lilia Hernández-Bravo
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
| | - Manuel A. Candia-Ramírez
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
| | - Rodrigo Gopar-Nieto
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
| | - Héctor González-Pacheco
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
| | - Jorge Daniel Sierra-Lara Martinez
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
| | - Alexandra Arias-Mendoza
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
| | - Diego Araiza-Garaygordobil
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
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Tsai T, Tsai M, Chen D, Lin Y, Peng J, Yang N, Hung M, Chen T. Evaluating the applicability of ivabradine in acute heart failure. Clin Cardiol 2024; 47:e24206. [PMID: 38269634 PMCID: PMC10765997 DOI: 10.1002/clc.24206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/06/2023] [Accepted: 12/04/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND While ivabradine has demonstrated benefits in heart rate control and prognosis for chronic heart failure patients, its application in acute decompensated heart failure remains underexplored. HYPOTHESIS For patients with acute decompensated heart failure with reduced ejection fraction (HFrEF) who are intolerant to β-blockers or unable to further titrate their dosage, the use of ivabradine is hypothesized to be effective and safe is improving outcomes. METHODS This retrospective, multicenter database analysis included patients with hospitalized decompensated heart failure with a left ventricular ejection fraction of ≤40% from June 1, 2015 to December 31, 2020. The exclusion criteria were a baseline heart rate of <70 bpm, previous use of ivabradine, mortality during admission, existing atrial fibrillation, or atrial flutter. The primary outcome was the composite of cardiovascular death and hospitalization for heart failure. RESULTS Of the 4163 HFrEF patients analyzed, 684 (16.4%) were administered ivabradine during their index admission. After matching, there were 617 patients in either group. The results indicated that ivabradine use was not significantly associated with the risk of the primary composite outcome (hazard ratio: 1.10; 95% confidence interval: 0.94-1.29). Similarly, the risk of secondary outcomes and adverse renal events did not significantly differ between the ivabradine and non-ivabradine cohorts (all p > .05). CONCLUSION For hospitalized acute decompensated heart failure patients who are intolerant to β-blockers or cannot further titrate them, ivabradine offers a consistent therapeutic effect. No significant disparities were noted between the ivabradine and non-ivabradine groups in heart failure hospitalization and cardiovascular death.
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Affiliation(s)
- Tzu‐Hsien Tsai
- Department of Internal Medicine, Division of CardiologyDitmanson Medical Foundation Chiayi Christian HospitalChiayiTaiwan
| | - Ming‐Lung Tsai
- Department of Internal Medicine, Division of CardiologyNew Taipei Municipal TuCheng HospitalNew TaipeiTaiwan
- College of MedicineChang Gung UniversityTaoyuanTaiwan
- College of ManagementChang Gung UniversityTaoyuanTaiwan
| | - Dong‐Yi Chen
- College of MedicineChang Gung UniversityTaoyuanTaiwan
- Department of Internal Medicine, Division of CardiologyLinkou Chang Gung Memorial HospitalTaoyuanTaiwan
| | - Yuan Lin
- College of MedicineChang Gung UniversityTaoyuanTaiwan
- Department of Emergency MedicineKeelung Chang Gung Memorial HospitalKeelungTaiwan
| | - Jian‐Rong Peng
- Department of Internal Medicine, Division of CardiologyNew Taipei Municipal TuCheng HospitalNew TaipeiTaiwan
- College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Ning‐I Yang
- College of MedicineChang Gung UniversityTaoyuanTaiwan
- Department of Internal Medicine, Division of CardiologyKeelung Chang Gung Memorial HospitalKeelungTaiwan
| | - Ming‐Jui Hung
- College of MedicineChang Gung UniversityTaoyuanTaiwan
- Department of Internal Medicine, Division of CardiologyKeelung Chang Gung Memorial HospitalKeelungTaiwan
| | - Tien‐Hsing Chen
- College of MedicineChang Gung UniversityTaoyuanTaiwan
- Department of Internal Medicine, Division of CardiologyKeelung Chang Gung Memorial HospitalKeelungTaiwan
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Oh GC, An S, Lee H, Cho H, Jeon E, Lee SE, Kim J, Kang S, Hwang K, Cho M, Chae SC, Choi D, Yoo B, Kim KH, Park SK, Baek SH. Modified reverse shock index predicts early outcomes of heart failure with reduced ejection fraction. ESC Heart Fail 2022; 9:3232-3240. [PMID: 35775109 PMCID: PMC9715832 DOI: 10.1002/ehf2.14031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 05/16/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS Increased blood pressure (BP) and decreased heart rate (HR) are signs of stabilization in patients admitted for acute HF. Changes in BP and HR during admission and their correlation with outcomes were assessed in hospitalized patients with heart failure (HF) with reduced ejection fraction (HFrEF). METHODS A novel modified reverse shock index (mRSI), defined as the ratio between changes in systolic BP and HR during admission, was devised, and its prognostic value in the early outcomes of acute HF was assessed using the Korean Acute HF registry. RESULTS Among 2697 patients with HFrEF (mean age 65.8 ± 14.9 years, 60.6% males), patients with mRSI ≥1.25 at discharge were significantly younger and were more likely to have de novo HF. An mRSI ≥1.25 was associated with a significantly lower incidence of 60-day and 180-day all-cause mortality [hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.31-0.77; HR 0.62, 95% CI 0.45-0.85, respectively], compared with 1 ≤ mRSI < 1.25 (all P < 0.001). Conversely, an mRSI <0.75 was associated with a significantly higher incidence of 60-day and 180-day all-cause mortality (adjusted HR 2.08, 95% CI 1.19-3.62; HR 2.24, 95% CI 1.53-3.27; all P < 0.001). The benefit associated with mRSI ≥1.25 was consistent in sub-group analyses. The correlation of mRSI and outcomes were also consistent regardless of admission SBP, presence of atrial fibrillation, or use of beta blockers at discharge. CONCLUSIONS In patients hospitalized for HFrEF, the mRSI was a significant predictor of early outcomes. The mRSI could be used as a tool to assess patient status and guide physicians in treating patients with HFrEF.
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Affiliation(s)
- Gyu Chul Oh
- Department of Internal Medicine, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
- Catholic Research Institute for Intractable Cardiovascular Disease (CRID), College of MedicineThe Catholic University of KoreaSeoulSouth Korea
| | - Seokyung An
- Department of Biomedical ScienceSeoul National University Graduate SchoolSeoulSouth Korea
- Cancer Research InstituteSeoul National UniversitySeoulSouth Korea
| | - Hae‐Young Lee
- Department of Internal MedicineSeoul National University HospitalSeoulSouth Korea
| | - Hyun‐Jai Cho
- Department of Internal MedicineSeoul National University HospitalSeoulSouth Korea
| | - Eun‐Seok Jeon
- Department of Internal MedicineSungkyunkwan University College of MedicineSeoulSouth Korea
| | - Sang Eun Lee
- Department of Internal Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - Jae‐Joong Kim
- Department of Internal Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - Seok‐Min Kang
- Department of Internal MedicineYonsei University College of MedicineSeoulSouth Korea
| | - Kyung‐Kuk Hwang
- Department of Internal MedicineChungbuk National University College of MedicineCheongjuSouth Korea
| | - Myeong‐Chan Cho
- Department of Internal MedicineChungbuk National University College of MedicineCheongjuSouth Korea
| | - Shung Chull Chae
- Department of Internal Medicine, School of MedicineKyungpook National UniversityDaeguSouth Korea
| | - Dong‐Ju Choi
- Department of Internal MedicineSeoul National University Bundang HospitalSeongnamSouth Korea
| | - Byung‐Su Yoo
- Department of Internal MedicineYonsei University Wonju College of MedicineWonjuSouth Korea
| | - Kye Hun Kim
- Department of Internal MedicineHeart Research Center of Chonnam National UniversityGwangjuSouth Korea
| | - Sue K. Park
- Cancer Research InstituteSeoul National UniversitySeoulSouth Korea
- Department of Integrated Major in Innovative Medical ScienceSeoul National University Graduate SchoolSeoulSouth Korea
| | - Sang Hong Baek
- Department of Internal Medicine, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
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McNamara PJ, Giesinger RE, Lakshminrusimha S. Dopamine and Neonatal Pulmonary Hypertension-Pressing Need for a Better Pressor? J Pediatr 2022; 246:242-250. [PMID: 35314154 DOI: 10.1016/j.jpeds.2022.03.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/07/2022] [Accepted: 03/15/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Patrick J McNamara
- Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, IA.
| | - Regan E Giesinger
- Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Satyan Lakshminrusimha
- Division of Neonatology, Department of Pediatrics, University of California Davis, Sacramento, CA
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